Healthcare Provider Details

I. General information

NPI: 1063457208
Provider Name (Legal Business Name): FAROOQUE S.A. KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 CROUSE LANE SUITE D
BURLINGTON NC
27215-8833
US

IV. Provider business mailing address

2961 CROUSE LANE SUITE D
BURLINGTON NC
27215-8833
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-7050
  • Fax: 336-584-7066
Mailing address:
  • Phone: 336-584-7050
  • Fax: 336-584-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number016016
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: