Provider Demographics
NPI:1285861823
Name:KHAN, NAGHMA RAIS (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGHMA
Middle Name:RAIS
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3512
Mailing Address - Country:US
Mailing Address - Phone:484-421-1669
Mailing Address - Fax:610-325-0459
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:SUITE 625
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3512
Practice Address - Country:US
Practice Address - Phone:484-421-1669
Practice Address - Fax:610-325-0459
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD445860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA440771OtherMLHC MEDICARE AA #
PA440771OtherMLHC MEDICARE AA #