Provider Demographics
NPI:1669033163
Name:KHAN, ROHMA (MD)
Entity Type:Individual
Prefix:
First Name:ROHMA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TAMPA GENERAL CIRCLE, HMT 750
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3601
Mailing Address - Country:US
Mailing Address - Phone:813-844-3397
Mailing Address - Fax:813-844-1934
Practice Address - Street 1:5 TAMPA GENERAL CIRCLE, HMT 750
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3601
Practice Address - Country:US
Practice Address - Phone:813-844-3397
Practice Address - Fax:813-844-1934
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019022847207R00000X
FLME157241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXR3GVOtherBLUE CROSS BLUE SHIELD
FL115720800Medicaid