Provider Demographics
NPI:1104828250
Name:KHAN, WASIL (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:WASIL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 EISENHOWER DR
Mailing Address - Street 2:BLDG 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3928
Mailing Address - Country:US
Mailing Address - Phone:912-527-5335
Mailing Address - Fax:912-527-5336
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:BLDG 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-527-5335
Practice Address - Fax:912-527-5336
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056116207RA0201X
SC27796207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I032048Medicare PIN
I34430Medicare UPIN