Healthcare Provider Details

I. General information

NPI: 1235733957
Provider Name (Legal Business Name): FAHAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 BDA FELIX CORDOVA DAVILA
MANATI PR
00674-6005
US

IV. Provider business mailing address

182 BDA FELIX CORDOVA DAVILA
MANATI PR
00674-6005
US

V. Phone/Fax

Practice location:
  • Phone: 939-497-1250
  • Fax:
Mailing address:
  • Phone: 939-497-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000832-P.A.
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25151
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: