Provider Demographics
NPI:1033183231
Name:KHAN, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:A
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 1:6941 ELAINE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2877
Mailing Address - Country:US
Mailing Address - Phone:716-298-8133
Mailing Address - Fax:716-298-8136
Practice Address - Street 1:6941 ELAINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2877
Practice Address - Country:US
Practice Address - Phone:716-298-8133
Practice Address - Fax:716-298-8136
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255520207RS0012X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH45242Medicare UPIN
NYCC8646Medicare ID - Type UnspecifiedMEDICARE NUMBER