Provider Demographics
NPI:1952576399
Name:M.O. KHAN, MD.,PA.
Entity Type:Organization
Organization Name:M.O. KHAN, MD.,PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:O
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-259-5150
Mailing Address - Street 1:55 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1535
Mailing Address - Country:US
Mailing Address - Phone:803-259-5150
Mailing Address - Fax:803-259-9078
Practice Address - Street 1:55 IRVING ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1535
Practice Address - Country:US
Practice Address - Phone:803-259-5150
Practice Address - Fax:803-259-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8422261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC084223Medicaid
SCD906520281Medicare PIN
SCD90652Medicare UPIN