Provider Demographics
NPI:1932359825
Name:KHAN, KASHIF ABDULLAH (MD)
Entity type:Individual
Prefix:DR
First Name:KASHIF
Middle Name:ABDULLAH
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 1:1251 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1434
Mailing Address - Country:US
Mailing Address - Phone:570-342-8434
Mailing Address - Fax:570-299-2521
Practice Address - Street 1:470 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3603
Practice Address - Country:US
Practice Address - Phone:570-342-8434
Practice Address - Fax:570-288-1084
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4478732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2604611262OtherBCBSMI
MI03860OtherPARAMOUNT
MI383049015OtherGREAT LAKES HEALTH PLAN
MI1932359825Medicaid
MI2604611262OtherBCBSMI