MEDICARE: AHMED 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	207R00000X	Internal Medicine Physician	13265	TN
2	207RC0000X	Cardiovascular Disease Physician	13265	TN
3	207RI0011X	Interventional Cardiology Physician	13265	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01457780	OTHER	TN	RAILROAD MEDICARE

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
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639165277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMED A. KHAN MD

Provider Business Mailing Address
First Line	:	310 N STATE OF FRANKLIN RD
Second Line	:	SUITE 400
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6008
Country	:	US
Telephone Number	:	423-979-6000
Fax Number	:	423-979-6011

Provider Business Practice Location Address
First Line	:	310 N STATE OF FRANKLIN RD
Second Line	:	SUITE 400
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6008
Country	:	US
Telephone Number	:	423-979-6000
Fax Number	:	423-979-6011

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/15/2017

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Directions to “ AHMED A. KHAN MD” Practice Location

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