MEDICARE: DR. MOHAMMAD ALI 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	324500000X	Substance Abuse Rehabilitation Facility	MD429242	PA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	D0064698	MD
3	207QA0505X	Adult Medicine Physician	15427R	LA
4	2080P0207X	Pediatric Hematology & Oncology Physician	15427R	LA
5	324500000X	Substance Abuse Rehabilitation Facility	15427R	LA
6	208M00000X	Hospitalist Physician	D0064698	MD
7	208000000X	Pediatrics Physician	D0064698	MD
8	208000000X	Pediatrics Physician	C1-0008136	DE
9	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	15427R	LA
10	2080A0000X	Pediatric Adolescent Medicine Physician	C1-0008136	DE
11	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	C1-0008136	DE
12	2080P0207X	Pediatric Hematology & Oncology Physician	D0064698	MD
13	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	15427R	LA
14	207QA0401X	Addiction Medicine (Family Medicine) Physician	15427R	LA
15	208000000X	Pediatrics Physician	15427R	LA

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

General Provider Information

NPI Number	:	1639113285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMAD ALI KHAN MD

Provider Business Mailing Address
First Line	:	2600 GLASGOW AVE STE 212
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-5704
Country	:	US
Telephone Number	:	302-449-5791
Fax Number	:	443-350-9783

Provider Business Practice Location Address
First Line	:	2600 GLASGOW AVE STE 212
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19702-5704
Country	:	US
Telephone Number	:	302-449-5791
Fax Number	:	443-350-9783

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	12/12/2025

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