Provider Demographics
NPI:1730179276
Name:KHAN, MOHAMMAD FARRUKH (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:FARRUKH
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 1:1600 PERRINEVILLE RD STE 2-303
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4923
Mailing Address - Country:US
Mailing Address - Phone:216-273-9800
Mailing Address - Fax:216-273-9998
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-653-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029897208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30021732OtherKEYSTONE MERCY
PA1011920410001Medicaid
PA7542074OtherAETNA HMO
PA01884714OtherBLUE SHIELD
PA2357937000OtherKEYSTONE HEALTH PLAN EAST
PA1064610OtherAETNA PPO
PA1064610OtherAETNA PPO
PA088485R94Medicare PIN