Provider Demographics
NPI:1831409614
Name:MAHMOOD A KHAN PRIMARY CARE PC
Entity type:Organization
Organization Name:MAHMOOD A KHAN PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-842-0200
Mailing Address - Street 1:5032 STATE HIGHWAY 30
Mailing Address - Street 2:MEDICAL PLAZA
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7534
Mailing Address - Country:US
Mailing Address - Phone:518-842-0200
Mailing Address - Fax:518-842-3003
Practice Address - Street 1:5032 STATE HIGHWAY 30
Practice Address - Street 2:MEDICAL PLAZA
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7534
Practice Address - Country:US
Practice Address - Phone:518-842-0200
Practice Address - Fax:518-842-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty