Healthcare Provider Details

I. General information

NPI: 1730635020
Provider Name (Legal Business Name): ZOHEIR KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 POMEROY AVE
MERIDEN CT
06450-7482
US

IV. Provider business mailing address

61 POMEROY AVE
MERIDEN CT
06450-7482
US

V. Phone/Fax

Practice location:
  • Phone: 203-694-5444
  • Fax: 203-694-5373
Mailing address:
  • Phone: 203-694-5444
  • Fax: 203-694-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT212093
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number070168
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number37780
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37780
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: