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General NPI Number Information
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NPI Number | 1205818911
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Entity Type | Individual
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Provider Name | DASTAGIR ALAM KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 27 DYKE RD
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City | LATHAM
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State | NY
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Zip | 12110-1237
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Country | US
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Telephone | 904-955-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 27 DYKE RD
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City | LATHAM
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State | NY
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Zip | 12110-1237
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Country | US
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Telephone | 904-955-7190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 281049
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 281049
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License Number State | NY
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