Provider Demographics
NPI:1871594077
Name:KHAN, FARRUKH AHMED (MD)
Entity type:Individual
Prefix:
First Name:FARRUKH
Middle Name:AHMED
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2775
Practice Address - Country:US
Practice Address - Phone:570-271-7836
Practice Address - Fax:570-271-8795
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084666207RC0000X
FL100804207RC0000X
PAMD449816207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04582OtherPARAMOUNT
MI4680700Medicaid
MI4680719Medicaid
OH2500976Medicaid
OHP00142700OtherRRMC
OH364176019-00OtherBWC
OH000000337213OtherAETNA
OH24-46644OtherUHC
OH7558554OtherAETNA
MI4680728Medicaid
OHP00142700OtherRRMC
OH364176019-00OtherBWC