Provider Demographics
NPI:1679569214
Name:KHAN, MEHDI A (DO)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6637 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5974
Mailing Address - Country:US
Mailing Address - Phone:716-632-1595
Mailing Address - Fax:716-204-4895
Practice Address - Street 1:6637 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5974
Practice Address - Country:US
Practice Address - Phone:716-632-1595
Practice Address - Fax:716-204-4895
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233770207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI35215Medicare UPIN
NYRA7443Medicare ID - Type Unspecified