Provider Demographics
NPI:1174780100
Name:KHAN, ASIM H (MD)
Entity type:Individual
Prefix:
First Name:ASIM
Middle Name:H
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WALT WHITMAN AVE UNIT 1268
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-8060
Mailing Address - Country:US
Mailing Address - Phone:856-577-1435
Mailing Address - Fax:856-780-6219
Practice Address - Street 1:1919 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1115
Practice Address - Country:US
Practice Address - Phone:856-577-1435
Practice Address - Fax:856-780-6219
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08401600207L00000X, 207LP2900X, 2086S0129X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222041639OtherTAX ID