Basic Information
| Provider Information | |||||||||
| NPI: | 1659378263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | JAMSHED | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 W 27TH ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107397551 | ||||||||
| FaxNumber: | 9107392332 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 W 27TH ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107397551 | ||||||||
| FaxNumber: | 9107392332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2005 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 200300054 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 200300054 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89133Y2 | 05 | NC | MEDICAID |