Provider Demographics
NPI:1083604433
Name:KHAN, MEHERNOSH PHEROZE (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHERNOSH
Middle Name:PHEROZE
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 1:55 PITTSFILED RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240
Mailing Address - Country:US
Mailing Address - Phone:413-344-1700
Mailing Address - Fax:413-728-8790
Practice Address - Street 1:631B NORTH STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-499-2054
Practice Address - Fax:413-445-9174
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25344207QA0505X
PAMD038265L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093827AMedicaid
PA0008041750009Medicaid
PA0008041750009Medicaid
PA080148436Medicare PIN
PA129777Medicare PIN