Provider Demographics
NPI:1609815307
Name:KHAN, MOHAMMED ABDUL RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ABDUL RAHMAN
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 1:59 LINREE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9075
Mailing Address - Country:US
Mailing Address - Phone:610-372-2525
Mailing Address - Fax:610-372-2345
Practice Address - Street 1:35 N 6TH ST # 101
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3522
Practice Address - Country:US
Practice Address - Phone:610-372-2525
Practice Address - Fax:610-372-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4186692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH65373Medicare UPIN