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General NPI Number Information
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NPI Number | 1740430545
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Entity Type | Individual
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Provider Name | MOAZZEM HOSSAIN KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | HAVILAND HALL 12 JOYCE DRIVE
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City | MIDDLETOWN
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State | CT
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Zip | 06457-6407
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Country | US
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Telephone | 860-262-7026
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Fax | 860-262-6525
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Provider Business Mailing Address
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Address Line | HAVILAND HALL 12 JOYCE DRIVE
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City | MIDDLETOWN
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State | CT
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Zip | 06457-1886
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Country | US
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Telephone | 347-446-9114
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Fax | 860-262-6525
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 67320
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License Number State | CT
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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 | 4933
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License Number State | AK
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