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General NPI Number Information
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NPI Number | 1992924906
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Entity Type | Individual
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Provider Name | IRM KHAN P.A.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 353 MAIN ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4145
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Country | US
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Telephone | 860-649-3477
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Fax |
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Provider Business Mailing Address
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Address Line | 75 REDWOOD DR #610
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City | EAST HAVEN
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State | CT
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Zip | 06513-1970
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Country | US
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Telephone | 203-468-1982
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001833
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License Number State | CT
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