Provider Demographics
NPI:1174219943
Name:KHAN, FATIM (MD)
Entity type:Individual
Prefix:MRS
First Name:FATIM
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:MAIMONIDES MEDICAL CENTER
Mailing Address - Street 2:4802 10TH AVENUE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219
Mailing Address - Country:US
Mailing Address - Phone:718-283-7040
Mailing Address - Fax:718-283-8498
Practice Address - Street 1:MAIMONIDES MEDICAL CENTER
Practice Address - Street 2:4802 10TH AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-283-7040
Practice Address - Fax:718-283-8498
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2024-08-23
Deactivation Date:2023-11-17
Deactivation Code:
Reactivation Date:2024-08-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program