Healthcare Provider Details

I. General information

NPI: 1073447058
Provider Name (Legal Business Name): RAMATULAI LATIFA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ELWYN RD
MEDIA PA
19063-4622
US

IV. Provider business mailing address

52 PAISLEY ST
BEAR DE
19701-4718
US

V. Phone/Fax

Practice location:
  • Phone: 302-724-8114
  • Fax:
Mailing address:
  • Phone: 302-724-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH007847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: