MEDICARE: DR. FAROOQUE S.A. 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	016016	ME

General Provider Information

NPI Number	:	1063457208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAROOQUE S.A. KHAN MD

Provider Business Mailing Address
First Line	:	3721 W MARKET ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1374
Country	:	US
Telephone Number	:	336-584-7050
Fax Number	:	336-584-7066

Provider Business Practice Location Address
First Line	:	3721 W MARKET ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1374
Country	:	US
Telephone Number	:	336-584-7050
Fax Number	:	336-584-7066

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	01/05/2026

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