Provider Demographics
NPI:1184852626
Name:KHAN, IMRAN AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:AHMAD
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 1:42 E LAUREL RD STE 3100
Mailing Address - Street 2:ADMINISTRATIVE OFFICE
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-6845
Mailing Address - Fax:856-566-6906
Practice Address - Street 1:42 E LAUREL RD STE 3100
Practice Address - Street 2:ADMINISTRATIVE OFFICE
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-6845
Practice Address - Fax:856-566-6906
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253657208M00000X
NJ25MA08885800207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0299065Medicaid