Provider Demographics
NPI:1538180427
Name:KHAGHAN, NEDA (MD)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:KHAGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W PUTNAM AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6086
Mailing Address - Country:US
Mailing Address - Phone:203-863-2900
Mailing Address - Fax:203-863-2901
Practice Address - Street 1:500 W PUTNAM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6086
Practice Address - Country:US
Practice Address - Phone:203-863-2900
Practice Address - Fax:203-863-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039573207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001395731Medicaid
CT039573OtherCOMMERCIAL
CT010039573CT01OtherCT BLUE CROSS BLUE SHIELD