Provider Demographics
NPI:1811938491
Name:KHAN, OMAR A (MD, MHS)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLEARWATER CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7800
Mailing Address - Country:US
Mailing Address - Phone:802-985-1131
Mailing Address - Fax:
Practice Address - Street 1:1309 VEALE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4609
Practice Address - Country:US
Practice Address - Phone:302-478-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42011038207Q00000X
DEC1-0008006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine