Provider Demographics
NPI:1861406613
Name:KHAN, TALAL NAJEEB (MD)
Entity type:Individual
Prefix:
First Name:TALAL
Middle Name:NAJEEB
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 1:299 CAREW ST. STE 234
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-787-2575
Mailing Address - Fax:413-787-2576
Practice Address - Street 1:98 SHAKER ROAD
Practice Address - Street 2:
Practice Address - City:EAST LONG MEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-798-0301
Practice Address - Fax:413-224-2685
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085212AMedicaid
MA110085212AMedicaid