Provider Demographics
NPI:1649431800
Name:KHAN, NAVEED A (MD)
Entity type:Individual
Prefix:
First Name:NAVEED
Middle Name:A
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 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:1101 6TH AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4306
Practice Address - Country:US
Practice Address - Phone:817-632-5803
Practice Address - Fax:817-336-1331
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116020628390200000X
NC2012-013702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program