Provider Demographics
NPI:1790945996
Name:KHAN, AMZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AMZAD
Middle Name:
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 1:234A BANK ST.
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6054
Mailing Address - Country:US
Mailing Address - Phone:860-442-0290
Mailing Address - Fax:860-442-2136
Practice Address - Street 1:234A BANK ST.
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6054
Practice Address - Country:US
Practice Address - Phone:860-442-0290
Practice Address - Fax:860-442-2136
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049522207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008031151Medicaid