Healthcare Provider Details

I. General information

NPI: 1730073628
Provider Name (Legal Business Name): MOHAMMAD KHAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 OAK ST
PITTSTON PA
18640-3798
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-9800
  • Fax: 814-359-7611
Mailing address:
  • Phone: 570-808-9800
  • Fax: 814-359-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMT235186
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLT001139
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: