Healthcare Provider Details

I. General information

NPI: 1205217981
Provider Name (Legal Business Name): JAHANGIR KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MEDICAL ARTS BLVD STE 106A
ANDERSON IN
46011-3461
US

IV. Provider business mailing address

1469 8TH AVE
BETHLEHEM PA
18018-2256
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-4660
  • Fax:
Mailing address:
  • Phone: 484-526-7800
  • Fax: 866-732-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT209760
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD465682
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01097273A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: