Provider Demographics
NPI:1336188168
Name:KHAN, MUJAHID H (MD)
Entity Type:Individual
Prefix:DR
First Name:MUJAHID
Middle Name:H
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 1:1244 EAST MARKET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6606
Mailing Address - Country:US
Mailing Address - Phone:330-392-3191
Mailing Address - Fax:330-395-6970
Practice Address - Street 1:1244 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6606
Practice Address - Country:US
Practice Address - Phone:330-392-3191
Practice Address - Fax:330-395-6970
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0356207Medicaid
OH0356207Medicaid
OHMU443666Medicare ID - Type Unspecified
A77443Medicare UPIN