Provider Demographics
NPI:1912009630
Name:KHAN, MOHAMMED ABDUL RAHMAN (DDS MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED ABDUL
Middle Name:RAHMAN
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 ASHWOOD DR STE 1204
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-4982
Mailing Address - Country:US
Mailing Address - Phone:724-745-3333
Mailing Address - Fax:724-745-3335
Practice Address - Street 1:1200 ASHWOOD DR STE 1204
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-4982
Practice Address - Country:US
Practice Address - Phone:724-745-3333
Practice Address - Fax:724-745-3335
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS029596L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKH050810Medicare ID - Type Unspecified
U86871Medicare UPIN