Provider Demographics
NPI:1184677494
Name:KHAN, DAVID B (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:KHAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:908-277-8876
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:SUMMIT MEDICAL GROUP
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-273-4300
Practice Address - Fax:908-277-8876
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00144100363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ53526Medicare UPIN
NJ095011Medicare PIN