Provider Demographics
NPI:1740272012
Name:KHAN, NIKHAT NASREEN (DO)
Entity type:Individual
Prefix:
First Name:NIKHAT
Middle Name:NASREEN
Last Name:KHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ST. PAUL DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4231
Mailing Address - Country:US
Mailing Address - Phone:717-217-6789
Mailing Address - Fax:717-496-8073
Practice Address - Street 1:69 ST. PAUL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4231
Practice Address - Country:US
Practice Address - Phone:717-217-6789
Practice Address - Fax:717-496-8073
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076672Medicare PIN
PAF65289Medicare UPIN