Provider Demographics
NPI:1053401430
Name:KHAN, FOZIA MUHSTAQE (MD)
Entity type:Individual
Prefix:DR
First Name:FOZIA
Middle Name:MUHSTAQE
Last Name:KHAN
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 1:2991 CROUSE LANE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:336-586-0994
Mailing Address - Fax:336-586-9363
Practice Address - Street 1:2991 CROUSE LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8833
Practice Address - Country:US
Practice Address - Phone:336-586-0994
Practice Address - Fax:336-586-9363
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC263669OtherM.D.
NC5177OtherM.D.
NC37245OtherM.D.
NC0407830OtherUHC PROVIDER NUMBER
NC5955667OtherM.D.
NC83435OtherMEDCOST PROVIDER NUMBER
NC8911599Medicaid
NC11599OtherBCBS PROVIDRE NUMBER
NC27313OtherPARTNERS PROVIDER M.D.
NC62413OtherM.D.
NC20428OtherM.D.
NC37245OtherM.D.
NC22531499BMedicare ID - Type UnspecifiedPROVIDER NUMBER, M.D.