Healthcare Provider Details

I. General information

NPI: 1861620452
Provider Name (Legal Business Name): ANSAR KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E FREDERICK ST
LANCASTER PA
17602-2222
US

IV. Provider business mailing address

133 E FREDERICK ST
LANCASTER PA
17602-2222
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-9821
  • Fax: 717-394-0175
Mailing address:
  • Phone: 717-394-9821
  • Fax: 717-394-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD450759
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT195943
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: