Provider Demographics
NPI:1497943435
Name:KHAN, MULAZIM H (MD)
Entity Type:Individual
Prefix:DR
First Name:MULAZIM
Middle Name:H
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 1:3 BRIDGE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1333
Mailing Address - Country:US
Mailing Address - Phone:315-493-0110
Mailing Address - Fax:315-493-1136
Practice Address - Street 1:3 BRIDGE ST STE 4
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1333
Practice Address - Country:US
Practice Address - Phone:315-493-0110
Practice Address - Fax:315-493-1136
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113496208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00469347Medicaid
NY00469347Medicaid