Healthcare Provider Details

I. General information

NPI: 1225045990
Provider Name (Legal Business Name): MUHAMMAD BAKHTIAR HUSAIN KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR
BELLEVILLE NJ
07109
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 908-653-9399
  • Fax: 908-653-9305
Mailing address:
  • Phone: 571-777-5157
  • Fax: 703-890-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA05606100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: