Provider Demographics
NPI:1235127747
Name:KHAN, AHMAD HAROON (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:HAROON
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 1:1267 CHERRY TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-7492
Mailing Address - Country:US
Mailing Address - Phone:717-446-0895
Mailing Address - Fax:717-753-3152
Practice Address - Street 1:765 FIFTH AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-446-0895
Practice Address - Fax:717-753-3152
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059857L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1599678Medicaid
PA885146Medicare PIN
PA1599678Medicaid