Provider Demographics
NPI:1912218686
Name:KHAN, MOEID (MD)
Entity Type:Individual
Prefix:DR
First Name:MOEID
Middle Name:
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 1:1000 ASYLUM AVE STE 2109A
Mailing Address - Street 2:SAINT FRANCIS MEDICAL GROUP INC
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1719
Mailing Address - Country:US
Mailing Address - Phone:860-714-2647
Mailing Address - Fax:
Practice Address - Street 1:490 BLUE HILLS AVE
Practice Address - Street 2:SAINT FRANCIS MECICAL GROUP, INC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1513
Practice Address - Country:US
Practice Address - Phone:860-714-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
62967390200000X
CT52828208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program