Provider Demographics
NPI:1871757096
Name:KHAN, RAHAT (M,D)
Entity type:Individual
Prefix:
First Name:RAHAT
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:M,D
Other - Prefix:
Other - First Name:RAHAT
Other - Middle Name:
Other - Last Name:BEGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:750 EAST ADAM
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-5136
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:750 EAST ADAM
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYASO552489498390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program