MEDICARE: DR. MASOOD N KHAN MD.,FACP

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	207R00000X	Internal Medicine Physician	20426	SC
2	207RC0000X	Cardiovascular Disease Physician	35007	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	48892	OTHER	NC	BLUE CROSS BLUE SHIELD
5	0220P	OTHER	NC	GROUP BLUE CROSS BLUE

General Provider Information

NPI Number	:	1588652218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASOOD N KHAN MD.,FACP

Provider Business Mailing Address
First Line	:	1401 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4549
Country	:	US
Telephone Number	:	704-347-0049
Fax Number	:	704-347-0049

Provider Business Practice Location Address
First Line	:	1401 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4549
Country	:	US
Telephone Number	:	704-347-0049
Fax Number	:	704-347-0049

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/10/2018

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