Provider Demographics
NPI:1902123995
Name:KHAN, ABDUL MANNAN (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:MANNAN
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:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 300A
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-7195
Practice Address - Fax:985-230-7196
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205106207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2103237Medicaid