Provider Demographics
NPI:1629052188
Name:KHAN, AYAZ M (MD)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
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 1:553 E 3RD ST
Mailing Address - Street 2:PAIN MANAGEMENT OF WILLIAMSPORT,LLC
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5316
Mailing Address - Country:US
Mailing Address - Phone:570-323-3106
Mailing Address - Fax:570-323-3606
Practice Address - Street 1:553 E 3RD ST
Practice Address - Street 2:PAIN MANAGEMENT OF WILLIAMSPORT
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5316
Practice Address - Country:US
Practice Address - Phone:570-323-3106
Practice Address - Fax:570-323-3606
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435280207LP2900X, 207LA0401X
NY002185207L00000X
NY251006207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629052188OtherNPI
NYAA1053Medicare PIN
1629052188OtherNPI
NYRA5364Medicare PIN