Healthcare Provider Details

I. General information

NPI: 1639813363
Provider Name (Legal Business Name): ARSLAN AHMED KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date: 07/05/2023
Reactivation Date: 08/16/2023

III. Provider practice location address

130 DIVISION ST
DERBY CT
06418-1326
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-1330
  • Fax: 203-732-1332
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84010
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: