Provider Demographics
NPI:1861697773
Name:MAHMOOD A. KHAN, M.D., P.C.
Entity type:Organization
Organization Name:MAHMOOD A. KHAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-842-0200
Mailing Address - Street 1:5032 STATE HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7534
Mailing Address - Country:US
Mailing Address - Phone:518-842-0200
Mailing Address - Fax:518-388-9911
Practice Address - Street 1:5032 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7534
Practice Address - Country:US
Practice Address - Phone:518-842-0200
Practice Address - Fax:518-388-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5867Medicare ID - Type UnspecifiedMC ID
NYH71794Medicare UPIN