Provider Demographics
NPI:1568431849
Name:KHAN, MOHAMMAD M (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:M
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-639-3955
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 130
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6799
Practice Address - Country:US
Practice Address - Phone:301-665-4710
Practice Address - Fax:301-665-4711
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61207-20207RH0003X
IN01050742A207RX0202X
MDD88494207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397211OtherPHCS PID NUMBER
IN000000269200OtherANTHEM PIN # / OIGL
IN11319874OtherCAQH NUMBER
IN200418760Medicaid
IN000000269189OtherANTHEM PIN # / ARNETT
IN815540HMedicare PIN
INP00011414Medicare PIN
IN142080GGMedicare PIN
IN11319874OtherCAQH NUMBER
IN200418760Medicaid
IN000000269200OtherANTHEM PIN # / OIGL
INH80590Medicare UPIN
IN815450OMedicare PIN