Healthcare Provider Details

I. General information

NPI: 1386768679
Provider Name (Legal Business Name): AHSAN M KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

1804 DELACOURT AVE
MOUNT PLEASANT SC
29466-9253
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7889
  • Fax:
Mailing address:
  • Phone: 843-364-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number35.074083
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number35074083
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: