Provider Demographics
NPI:1396956371
Name:KHAN, FAISAL MAHMOOD (MD, MBBS)
Entity type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:MAHMOOD
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD, MBBS
Other - Prefix:DR
Other - First Name:FAISAL
Other - Middle Name:M
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:400 US 70 HIGHWAY E
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4049
Practice Address - Country:US
Practice Address - Phone:919-662-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57008506207R00000X
OH35.094390207R00000X, 207RC0000X
NC2022-02775207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396956371Medicaid
OH3074980Medicaid
OHH370750Medicare PIN