Healthcare Provider Details

I. General information

NPI: 1154654739
Provider Name (Legal Business Name): ARBAB A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE SUITE 3201E
HARTFORD CT
06105-1770
US

IV. Provider business mailing address

15 GRACE VIEW DR
EASTON CT
06612-1261
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-2724
  • Fax: 860-714-8808
Mailing address:
  • Phone: 203-220-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberAS3501233
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number267307
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number49386
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: