MEDICARE: NIKHAT NASREEN KHAN D.O.

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	174400000X	Specialist	OS012881	PA

General Provider Information

NPI Number	:	1740272012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKHAT NASREEN KHAN D.O.

Provider Business Mailing Address
First Line	:	69 ST. PAUL DRIVE
Second Line	:	SUITE A
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-4231
Country	:	US
Telephone Number	:	717-217-6789
Fax Number	:	717-496-8073

Provider Business Practice Location Address
First Line	:	69 ST. PAUL DRIVE
Second Line	:	SUITE A
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-4231
Country	:	US
Telephone Number	:	717-217-6789
Fax Number	:	717-496-8073

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	06/29/2010

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