Provider Demographics
NPI:1508051277
Name:KHAN, SUMERA TARIQ (MD)
Entity Type:Individual
Prefix:
First Name:SUMERA
Middle Name:TARIQ
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-2414
Mailing Address - Fax:513-585-3792
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:STE. 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-2414
Practice Address - Fax:513-585-3792
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA358062084P0800X
OH35.0843722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2800142Medicaid
KY7100098720Medicaid
OH2800142Medicaid