Provider Demographics
NPI:1962424655
Name:KHAN, YUSUF MUJTABA (MD)
Entity type:Individual
Prefix:
First Name:YUSUF
Middle Name:MUJTABA
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 1:423 N PENNSYLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6622
Mailing Address - Country:US
Mailing Address - Phone:215-295-9131
Mailing Address - Fax:215-736-8535
Practice Address - Street 1:423 N PENNSYLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-6622
Practice Address - Country:US
Practice Address - Phone:215-295-9131
Practice Address - Fax:215-736-8535
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039495L207RP1001X
NJMA04637800207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3937101Medicaid
PA987612OtherPABS
PA0016703610001Medicaid
PA0529502000OtherKEYSTONE
C53599Medicare UPIN
PA0016703610001Medicaid
PA694513Medicare ID - Type Unspecified