Healthcare Provider Details

I. General information

NPI: 1073703369
Provider Name (Legal Business Name): AHMAD AFTAB KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 1E50
NEWARK DE
19718-4660
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1980
  • Fax: 302-733-1986
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberTP160
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC1-0026327
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number22795
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number22795
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1074898A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: