Healthcare Provider Details

I. General information

NPI: 1194766980
Provider Name (Legal Business Name): KHAN OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S STATE ST
DOVER DE
19901-4148
US

IV. Provider business mailing address

888 S STATE ST
DOVER DE
19901-4148
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-8720
  • Fax: 302-735-8724
Mailing address:
  • Phone: 302-735-8720
  • Fax: 302-735-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2002104386
License Number StateDE

VIII. Authorized Official

Name: MS. LISA SPRINGER
Title or Position: BILLING MANAGER
Credential:
Phone: 302-735-8720