Provider Demographics
NPI:1588652218
Name:KHAN, MASOOD N (MD,FACP)
Entity Type:Individual
Prefix:DR
First Name:MASOOD
Middle Name:N
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD,FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4549
Mailing Address - Country:US
Mailing Address - Phone:704-347-0049
Mailing Address - Fax:704-347-0049
Practice Address - Street 1:1401 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4549
Practice Address - Country:US
Practice Address - Phone:704-347-0049
Practice Address - Fax:704-347-0049
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20426207R00000X
NC35007207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN35007Medicaid
NC8948892Medicaid
NC890220PMedicaid
NC48892OtherBLUE CROSS BLUE SHIELD
NC0220POtherGROUP BLUE CROSS BLUE
SCN35007Medicaid
SCAA9597F694Medicare PIN
NC0220POtherGROUP BLUE CROSS BLUE
NC1316907405Medicare NSC