Provider Demographics
NPI:1932359825
Name:KHAN, KASHIF ABDULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:KASHIF
Middle Name:ABDULLAH
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 1:439 BLACK WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1566
Mailing Address - Country:US
Mailing Address - Phone:704-258-9230
Mailing Address - Fax:570-735-0186
Practice Address - Street 1:121 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634
Practice Address - Country:US
Practice Address - Phone:570-735-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4478732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2604611262OtherBCBSMI
MI383049015OtherGREAT LAKES HEALTH PLAN
MI03860OtherPARAMOUNT
MI1932359825Medicaid
MI2604611262OtherBCBSMI