Provider Demographics
NPI:1871345330
Name:KHAN, SIDRAH (MD)
Entity type:Individual
Prefix:MRS
First Name:SIDRAH
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GEISINGER WYOMING VALLEY MEDICAL CENTER
Mailing Address - Street 2:100 EAST MOUNTAIN BLVD
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0001
Mailing Address - Country:US
Mailing Address - Phone:570-808-3746
Mailing Address - Fax:570-808-5967
Practice Address - Street 1:GEISINGER WYOMING VALLEY MEDICAL CENTER
Practice Address - Street 2:100 EAST MOUNTAIN BLVD
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0001
Practice Address - Country:US
Practice Address - Phone:570-808-3746
Practice Address - Fax:570-808-5967
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program