Provider Demographics
NPI:1538131974
Name:KHAN, MOHAMMAD ABUL KALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ABUL KALAM
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 1:1751 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9287
Mailing Address - Country:US
Mailing Address - Phone:919-556-7499
Mailing Address - Fax:919-562-0943
Practice Address - Street 1:1751 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9287
Practice Address - Country:US
Practice Address - Phone:919-556-7499
Practice Address - Fax:919-562-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8948470Medicaid
NC2209928Medicare ID - Type Unspecified
NCF86331Medicare UPIN