Provider Demographics
NPI:1851378772
Name:KHAN, AHMED M (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 LIBERTY SQ
Mailing Address - Street 2:STE 105
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2637
Mailing Address - Country:US
Mailing Address - Phone:860-225-1227
Mailing Address - Fax:860-225-1253
Practice Address - Street 1:1 LIBERTY SQ FL 1
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2637
Practice Address - Country:US
Practice Address - Phone:860-225-1227
Practice Address - Fax:860-225-1253
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039336207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
010039336CT04OtherANTHEM
CTH37050Medicare UPIN
H37050Medicare UPIN