Provider Demographics
NPI:1578876991
Name:KHAN, IHSAN U (MD)
Entity Type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:U
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:161 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-798-5442
Mailing Address - Fax:607-798-5876
Practice Address - Street 1:161 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 305
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-798-5442
Practice Address - Fax:607-798-5876
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY254985207R00000X, 208D00000X, 207RP1001X
NY254985-1207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03361644Medicaid
NYJ400049365Medicare PIN