Healthcare Provider Details

I. General information

NPI: 1467867994
Provider Name (Legal Business Name): WAHEED KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MADISON AVE
SCRANTON PA
18510-2401
US

IV. Provider business mailing address

40 FORDHAM RD
SOMERSET NJ
08873-1063
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-2383
  • Fax:
Mailing address:
  • Phone: 732-986-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD466159
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: