Provider Demographics
NPI:1407067929
Name:KHAN, RAZA ALI (MD)
Entity type:Individual
Prefix:
First Name:RAZA
Middle Name:ALI
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 1:9336 BLAKENEY CENTRE DR STE 100B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6694
Mailing Address - Country:US
Mailing Address - Phone:704-862-4700
Mailing Address - Fax:704-862-4749
Practice Address - Street 1:9336 BLAKENEY CENTRE DR STE 100B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6694
Practice Address - Country:US
Practice Address - Phone:704-862-4700
Practice Address - Fax:704-862-4749
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH098280207L00000X, 207LP2900X, 208VP0014X
LAMD.203861207L00000X
NC2012-01447207L00000X, 208VP0014X, 207LP2900X
SC34704207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921949Medicaid
LA409952Medicaid
OH1407067929Medicaid
LA409952Medicaid
NCP01165757Medicare PIN
OH1407067929Medicaid