Provider Demographics
NPI:1184946428
Name:MOHAMMAD K. KHAN, M.D., LLC
Entity type:Organization
Organization Name:MOHAMMAD K. KHAN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:KHALID
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-319-1706
Mailing Address - Street 1:6594 RUTHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8049
Mailing Address - Country:US
Mailing Address - Phone:717-319-1706
Mailing Address - Fax:
Practice Address - Street 1:4949 LIBERTY LN STE 320
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9048
Practice Address - Country:US
Practice Address - Phone:717-319-1706
Practice Address - Fax:610-395-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056299-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102498458 0001Medicaid
PA2510096OtherHIGHMARK BLUE SHIELD
3826089000OtherINDEPENDENCE BLUE CROSS
7651921OtherAETNA
PA102498458 0001Medicaid