Provider Demographics
NPI:1265480073
Name:KHAN, MAHMOOD A (MD, MBBS,)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD, MBBS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 STATE HIGHWAY 30
Mailing Address - Street 2:MEDICAL PLAZA
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7534
Mailing Address - Country:US
Mailing Address - Phone:518-842-0200
Mailing Address - Fax:518-842-3003
Practice Address - Street 1:5032 STATE HIGHWAY 30
Practice Address - Street 2:MEDICAL PLAZA
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7534
Practice Address - Country:US
Practice Address - Phone:518-842-0200
Practice Address - Fax:518-842-3003
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491005Medicaid
NYH71794Medicare UPIN
NYDD5867Medicare PIN