Provider Demographics
NPI:1992794259
Name:KHAN, TASNEEM HUSSAINEE (MD)
Entity type:Individual
Prefix:DR
First Name:TASNEEM
Middle Name:HUSSAINEE
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TASNEEM
Other - Middle Name:
Other - Last Name:HUSSAINEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 O CONNOR DR
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1926
Mailing Address - Country:US
Mailing Address - Phone:570-371-1413
Mailing Address - Fax:866-259-6004
Practice Address - Street 1:501 S WASHINGTON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3814
Practice Address - Country:US
Practice Address - Phone:570-941-0630
Practice Address - Fax:570-343-3923
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA065153L2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13447Medicare UPIN
081859S5CMedicare ID - Type Unspecified