Provider Demographics
NPI:1497700439
Name:KHAN, MASHUKUR RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:MASHUKUR
Middle Name:RAHMAN
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 1:1400 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5114
Mailing Address - Country:US
Mailing Address - Phone:412-232-7388
Mailing Address - Fax:412-937-9221
Practice Address - Street 1:680 ANDERSEN DR
Practice Address - Street 2:FOSTER PLAZA 10
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2759
Practice Address - Country:US
Practice Address - Phone:412-937-8887
Practice Address - Fax:412-937-9221
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 073059L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C20645OtherPALMETTO GBA MEDICARE
H54796OtherCAN HEALTH PARTNERS
H54796OtherMEDICARE PQHC UGS
H54796OtherAETNA HEALTH PLANS
H54796OtherACORDIA NATIONAL
H54796OtherCIGNA PRO
H54796OtherHEALTH ASSURANCE PLAN
H54796OtherNCAS
H54796OtherRETIRED RAILROAD MEDICARE
H54796OtherUNITED HEALTHCARE
K385HTOtherCAREFIRST
054721FNNOtherPENNSYLVANIA MEDICARE
H43796OtherGROUP BENEFIT SERVICES
1327910OtherPENNSYLVANIA PERSONAL
3810001526OtherUNISYS
89715OtherMID ATLANTIC MEDICAL SERV
054721FNNOtherPENNSYLVANIA MEDICARE
H54796OtherNCAS
1327910OtherPENNSYLVANIA PERSONAL