MEDICARE: ATIF KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	243890	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200026	OTHER		LUNG
2	54183971800	OTHER		WV WORKERS COMPENSATION
3	5727853	OTHER		CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	236802	OTHER	WV	ANTHEM
6	541839718105	OTHER	WV	BS MOUNTAIN STATE
7	5400143	OTHER		CCN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	188426	OTHER		CARELINK
10	245780	OTHER	VA	ANTHEM
11	541839718101	OTHER	VA	BS MOUNTAIN STATE
12	7646497	OTHER		AETNA
13	188426	OTHER		SOUTHERN HEALTH
14	541839718	OTHER		C&O

General Provider Information

NPI Number	:	1063417145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATIF KHAN MD

Provider Business Mailing Address
First Line	:	131 OLD ROAD NINE ACRE CORNER
Second Line	:	JCB SUITE 500
City	:	CONCORD
State	:	MA
Zip	:	01742
Country	:	US
Telephone Number	:	978-287-3547
Fax Number	:	978-287-2949

Provider Business Practice Location Address
First Line	:	131 OLD ROAD NINE ACRE CORNER
Second Line	:	JCB SUITE 500
City	:	CONCORD
State	:	MA
Zip	:	01742
Country	:	US
Telephone Number	:	978-287-3547
Fax Number	:	978-287-2949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/15/2016

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Directions to “ ATIF KHAN MD” Practice Location

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