Provider Demographics
NPI:1669411120
Name:KHAN, NASIR MAHMOOD (MD)
Entity type:Individual
Prefix:
First Name:NASIR
Middle Name:MAHMOOD
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 1:3980 SHERIDAN DR
Mailing Address - Street 2:DENT TOWER SUIT 601
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1727
Mailing Address - Country:US
Mailing Address - Phone:716-961-9900
Mailing Address - Fax:716-961-9911
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:DENT TOWER SUIT 601
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-961-9900
Practice Address - Fax:716-961-9911
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210016207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01701220Medicaid
NYRB1763Medicare PIN