Provider Demographics
NPI:1548490998
Name:KHAN, MUZAFAR ALI (MD)
Entity type:Individual
Prefix:DR
First Name:MUZAFAR
Middle Name:ALI
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 1:427 SANTA ANITA DR
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-8313
Mailing Address - Country:US
Mailing Address - Phone:717-877-8026
Mailing Address - Fax:
Practice Address - Street 1:427 SANTA ANITA DR
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-8313
Practice Address - Country:US
Practice Address - Phone:717-877-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD447044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102851121Medicaid
PA2901256OtherHIGHMARK BLUE SHIELD
MD068488100Medicaid
PA309776FLTMedicare PIN
PA102851121Medicaid