Provider Demographics
NPI:1487638870
Name:KHAN, ALIYA USMAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALIYA
Middle Name:USMAN
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3075 GOVERNORS PLACE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1332
Mailing Address - Country:US
Mailing Address - Phone:937-296-0015
Mailing Address - Fax:937-296-0074
Practice Address - Street 1:3075 GOVERNORS PLACE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1332
Practice Address - Country:US
Practice Address - Phone:937-296-0015
Practice Address - Fax:937-296-0074
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35063979207RI0001X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2037727Medicaid
OH2037727Medicaid
G61239Medicare UPIN