Provider Demographics
NPI:1790498475
Name:KHAN, OMAR DARAZ
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:DARAZ
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 MISTY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9242
Mailing Address - Country:US
Mailing Address - Phone:518-380-6737
Mailing Address - Fax:
Practice Address - Street 1:8202 MISTY SHORE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9242
Practice Address - Country:US
Practice Address - Phone:518-380-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)