MEDICARE: DR. MUSTAFA ALI KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	70388	TN
2	2084N0400X	Neurology Physician	100524	GA
3	2084N0400X	Neurology Physician	84278	WI
4	2084N0400X	Neurology Physician	2023010521	MO
5	2084N0400X	Neurology Physician	2024-00360	NC
6	2084N0400X	Neurology Physician	01092448A	IN
7	2084N0400X	Neurology Physician	0101276849	VA
8	2084N0400X	Neurology Physician	ME168650	FL
9	2084N0400X	Neurology Physician	202568	NY
10	2084N0400X	Neurology Physician	036169424	IL

General Provider Information

NPI Number	:	1861489601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUSTAFA ALI KHAN MD

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NICOLLS RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-5151
Country	:	US
Telephone Number	:	631-444-8118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	02/10/2026

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