| LLC | |
|
835 W Chester Pike West Chester PA 19382-4863 | |
| (800) 528-0006 | |
| (732) 349-6030 |
| Full Name | LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 835 W Chester Pike, West Chester, Pennsylvania |
| Authorized Official Name and Position | Shabih Khan (PRESIDENT) |
| Authorized Official Contact | 6107382545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| LLC Po Box 427 Lederach PA 19450-0427 Ph: (800) 528-0006 | LLC 835 W Chester Pike West Chester PA 19382-4863 Ph: (800) 528-0006 |
| NPI Number | 1295764843 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 10/10/2012 |
| Medicare PECOS PAC ID | 6800834904 |
|---|---|
| Medicare Enrollment ID | O20050420000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295764843 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Shabih U Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578571063 PECOS PAC ID: 7315045689 Enrollment ID: I20070611000200 |
| Provider Name | Lauren Elizabeth Fairorth |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588216642 PECOS PAC ID: 8022469741 Enrollment ID: I20240108000553 |
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