Healthcare Provider Details

I. General information

NPI: 1811066244
Provider Name (Legal Business Name): SABA KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA - GASTROENTEROLOGY
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 E PENN SQ 9TH FL
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3247
  • Fax: 215-590-3606
Mailing address:
  • Phone: 267-425-9234
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD429443
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD429443
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: