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General NPI Number Information
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NPI Number | 1366431967
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Entity Type | Individual
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Provider Name | ANWAR M KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 536 SAYBROOK RD
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4783
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Country | US
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Telephone | 860-358-2100
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Fax | 860-358-2110
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Provider Business Mailing Address
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Address Line | 760 SAYBROOK RD
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4785
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Country | US
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Telephone |
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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 | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 041428
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License Number State | CT
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