Healthcare Provider Details

I. General information

NPI: 1467986059
Provider Name (Legal Business Name): AZIZ KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 MECHANICSVILLE RD STE 512
DOYLESTOWN PA
18902-1669
US

IV. Provider business mailing address

3900 MECHANICSVILLE RD STE 512
DOYLESTOWN PA
18902-1669
US

V. Phone/Fax

Practice location:
  • Phone: 267-805-8820
  • Fax: 267-805-8755
Mailing address:
  • Phone: 267-805-8820
  • Fax: 267-805-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57983
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD488226
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number064400
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number064400
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: