Moazzem Hossain Khan, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4933 Issued in AK

Practice address

Haviland Hall
12 Joyce Drive
Middletown, CT 06457-6407

Phone

(860) 262-7026

Fax

(860) 262-6525

NPI assigned

Sep 29, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of Connecticut

  • Psychiatric Hospital
  • Middletown, CT
  • NPI 1245256247
  Medicare reassignment NPD
• State of Connecticut

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1740430545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HAVILAND HALL",
            "address_2": "12 JOYCE DRIVE",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064571886",
            "telephone_number": "347-446-9114",
            "fax_number": "860-262-6525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HAVILAND HALL",
            "address_2": "12 JOYCE DRIVE",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064576407",
            "telephone_number": "860-262-7026",
            "fax_number": "860-262-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MOAZZEM",
        "middle_name": "HOSSAIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-29",
        "last_updated": "2024-02-02",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "67320",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AK",
            "license": "4933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Keramidas, RN
• Richard M. Ketai, M.D.
• Kevin O'Shea, PSYD LLC
• Hilary Osga Khacherian, OTRL
• Anwar M Khan, MD
• Rehan Khan
• Ali Khayyer, DDS
• Pamela Jean Kieras, MS LADC
• Kim Abram LLC
• Kevin W Kimmel, PA-C

• Internal Medicine Physician in Middletown, CT
• Providers in Middletown, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.