Provider Demographics
NPI:1841274545
Name:KHAN, NAZIM (MD)
Entity type:Individual
Prefix:DR
First Name:NAZIM
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6678
Mailing Address - Country:US
Mailing Address - Phone:919-782-8303
Mailing Address - Fax:919-782-8302
Practice Address - Street 1:2406 BLUE RIDGE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6678
Practice Address - Country:US
Practice Address - Phone:919-758-8303
Practice Address - Fax:919-782-8302
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900079207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1178XOtherBCBS NC
NC5901510Medicaid
NC1178XOtherBCBS NC
NCG41247Medicare UPIN