Basic Information
| Provider Information | |||||||||
| NPI: | 1952589236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE CARE MEDICAL ASSOCIATES P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157411963 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Practice Location | |||||||||
| Address1: | 1205 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157411963 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | ZAFAR | ||||||||
| AuthorizedOfficialMiddleName: | ALI | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR / OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2157411963 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD070945L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0018174090004 | 05 | PA | MEDICAID |