Healthcare Provider Details

I. General information

NPI: 1629137666
Provider Name (Legal Business Name): QADAR KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W GIRARD AVE
PHILADELPHIA PA
19123-1312
US

IV. Provider business mailing address

2239 DEER PATH RD
HUNTINGDON VALLEY PA
19006-5905
US

V. Phone/Fax

Practice location:
  • Phone: 215-440-9547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD033303L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: