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General NPI Number Information
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NPI Number | 1699982454
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Entity Type | Organization
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Legal Business Name | SKIN AND ALLERGY CLINIC, INC.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 6801 GRAYSTONE CIR NW DR. KHAN - DERMATOLOGIST
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City | CANTON
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State | OH
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Zip | 44718-1372
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Country | US
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Telephone | 330-546-0135
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Fax | 925-380-8129
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Provider Business Mailing Address
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Address Line | 6801 GRAYSTONE CIR NW DR. KHAN - DERMATOLOGIST
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City | CANTON
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State | OH
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Zip | 44718-1372
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Country | US
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Telephone | 330-546-0135
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Fax | 925-380-8129
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUSHTAQ AHMAD KHAN
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Credential |
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Telephone | 330-492-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35037786
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License Number State | OH
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