Provider Demographics
NPI:1174565816
Name:KHAN, NASREEN (DO)
Entity type:Individual
Prefix:DR
First Name:NASREEN
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4112
Mailing Address - Country:US
Mailing Address - Phone:302-735-8720
Mailing Address - Fax:302-735-8724
Practice Address - Street 1:1113 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4112
Practice Address - Country:US
Practice Address - Phone:302-735-8720
Practice Address - Fax:302-735-8724
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015028Medicaid
DE1000015028Medicaid
DE00B181K84Medicare ID - Type Unspecified