Healthcare Provider Details

I. General information

NPI: 1407067929
Provider Name (Legal Business Name): RAZA ALI KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9336 BLAKENEY CENTRE DR STE 100B
CHARLOTTE NC
28277-6694
US

IV. Provider business mailing address

9336 BLAKENEY CENTRE DR STE 100B
CHARLOTTE NC
28277-6694
US

V. Phone/Fax

Practice location:
  • Phone: 704-862-4700
  • Fax: 704-862-4749
Mailing address:
  • Phone: 704-862-4700
  • Fax: 704-862-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number098280
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.203861
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2012-01447
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34704
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number098280
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34704
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number098280
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2012-01447
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34704
License Number StateSC
# 10
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2012-01447
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: