Provider Demographics
NPI:1134514227
Name:KHAN, ALI TARIQ
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:TARIQ
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MITCHELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903
Mailing Address - Country:US
Mailing Address - Phone:607-772-0639
Mailing Address - Fax:
Practice Address - Street 1:1715 N GEORGE MASON DR STE 410
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3666
Practice Address - Country:US
Practice Address - Phone:703-524-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295395207R00000X
VA0101278813207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine