Individual provider Active NPI

Mustafa Ali Khan, MD

  • Neurology Physician
  • Stony Brook, NY
National Provider Identifier
1861489601
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
202568 Issued in NY
Practice address
100 Nicolls Rd
Stony Brook, NY 11794-5151
Phone
(631) 444-8118
NPI assigned
Oct 5, 2005
Last updated
Jul 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 2024-00360 NC
Neurology Physician 2084N0400X 2023010521 MO
Neurology Physician 2084N0400X 202568 NY Primary
Neurology Physician 2084N0400X ME168650 FL
Neurology Physician 2084N0400X 25443 NV
Neurology Physician 2084N0400X 100524 GA
Neurology Physician 2084N0400X 01092448A IN
Neurology Physician 2084N0400X 84278 WI
Neurology Physician 2084N0400X 0101276849 VA
Neurology Physician 2084N0400X 036169424 IL
Neurology Physician 2084N0400X 70388 TN

Addresses

Primary practice location

100 Nicolls Rd
Stony Brook, NY 11794-5151

Mailing address

1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 302-6565

Other practice location 1

300 Med Tech Pkwy
Johnson City, TN 37604-2277
Phone (423) 302-1000

Other practice location 2

127 Health Care Dr Ste 3
Pennington Gap, VA 24277-2853
Phone (423) 230-5000

Other practice location 3

1000 Johnson Ferry Rd
Atlanta, GA 30342-1606
Phone (404) 851-8000

Other practice location 4

1701 S Creasy Ln
Lafayette, IN 47905-4972
Phone (765) 502-4400

Other practice location 5

12200 Warwick Blvd Ste 110
Newport News, VA 23601-2344
Phone (757) 534-5100

Other practice location 6

1990 Holton Ave E
Big Stone Gap, VA 24219-3350
Phone (423) 230-8200

Other practice location 7

2000 Brookside Dr
Kingsport, TN 37660-4627
Phone (423) 857-7000

Other practice location 8

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

Other practice location 9

12200 Warwick Blvd Ste 110
Newport News, VA 23601-2344
Phone (757) 534-5100

Other practice location 10

16000 Johnston Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-1000

Other practice location 11

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 844-1121

Other practice location 12

1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1100

Other practice location 13

2030 Temple Hill Rd
Erwin, TN 37650-8721
Phone (423) 743-3141

Other practice location 14

1501 W Elk Ave
Elizabethton, TN 37643-2874
Phone (423) 542-1300

Other practice location 15

400 N State Of Franklin Rd
Johnson City, TN 37604-6035
Phone (423) 323-6900

Other practice location 16

1420 Tusculum Blvd
Greeneville, TN 37745-4279
Phone (423) 787-5000

Other practice location 17

365 Broadway
Kingston, NY 12401-5151
Phone (845) 331-5165 ext. 113

Other practice location 18

515 22nd Ave
Monroe, WI 53566-1569
Phone (608) 324-1000

Other practice location 19

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Other practice location 20

1519 Main St
Sneedville, TN 37869-3657
Phone (423) 733-5000

Other practice location 21

851 Locust St
Rogersville, TN 37857-2407
Phone (423) 921-7000

Other practice location 22

1102 W 32nd St
Joplin, MO 64804-3503
Phone (417) 347-4570

Other practice location 23

312 Hospital Dr
Clintwood, VA 24228-6786
Phone (276) 926-0300

Other practice location 24

58 Carroll St
Lebanon, VA 24266-4510
Phone (276) 883-8000

Other practice location 25

100 15th St NW
Norton, VA 24273-1616
Phone (423) 630-7001

Other practice location 26

245 Medical Park Dr
Marion, VA 24354-1100
Phone (276) 378-1000

Other practice location 27

6000 Hospital Dr
Hannibal, MO 63401-6887
Phone (573) 248-1300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MI, MO, TN, VA, IN, IL, MS, NC, GA, WI11 enrollments
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 11

Enrollment IDStateProvider typePAC IDDetails
I20080918000549 NY Practitioner - NeurologyPractitioner - Family Practice 0345317277 Reassigns benefits to 6 organizations
I20231226001684 MI Practitioner - Neurology 0345317277
I20240423003357 MO Practitioner - Neurology 0345317277 Reassigns benefits to 4 organizations
I20240516002800 TN Practitioner - Neurology 0345317277 Reassigns benefits to 1 organization
I20240520002549 VA Practitioner - Neurology 0345317277 Reassigns benefits to 2 organizations
I20240709003568 IN Practitioner - Neuropsychiatry 0345317277 Reassigns benefits to 2 organizations
I20240923002797 IL Practitioner - Neurology 0345317277 Reassigns benefits to 1 organization
I20241114001543 MS Practitioner - Neurology 0345317277 Reassigns benefits to 3 organizations
I20250102000797 NC Practitioner - Neurology 0345317277 Reassigns benefits to 3 organizations
I20250630000948 GA Practitioner - Neurology 0345317277 Reassigns benefits to 1 organization
I20260126000881 WI Practitioner - Neurology 0345317277 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians
Hendricks County HospitalGroup PAC ID 4880505528, 341 clinicians
Freeman-Oak Hill Health SystemGroup PAC ID 8325942253, shared by 14 NPIs, 385 clinicians
Wellmont Medical Associates IncGroup PAC ID 8123291739, shared by 2 NPIs, 432 clinicians
North Oaks Medical Center LLCGroup PAC ID 2466629522, 317 clinicians
Centra Medical Group LLCGroup PAC ID 4789606088, 709 clinicians
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
WakemedGroup PAC ID 7315937612, 72 clinicians
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians
Wyoming CountyGroup PAC ID 9335118967, 40 clinicians

Practice addresses (Care Compare)

Kingston, NY 12401
Phone (845) 417-3895

1000 E Main St
Danville, IN 46122-1948

1102 W 32 St
Joplin, MO 64804-3503

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

134 Forest Hill Dr
Kingston, NY 12401-7461
Phone (845) 417-3895

1500 Clayton Manor Dr
Apt 6
Liverpool, NY 13088-5373
Phone (434) 200-5047

16000 Johnson Memorial Dr
Abingdon, VA 24211-7664
Phone (276) 258-8200

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-5416

2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone (252) 847-1757

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

3603 Bienville Blvd
Ocean Springs, MS 39564-5727
Phone (228) 818-9620

400 N Main St
Warsaw, NY 14569-1025
Phone (585) 786-2233

6000 Hospital Dr PO Box
Suite 1257
Hannibal, MO 63401-1257

8244 E US Hwy 36
Avon, IN 46123-9688

8244 E US Hwy 36 1320
Avon Internal Medicine
Avon, IN 46123-9688
Phone (317) 272-7519

PO Box
Suite 1257
Hannibal, MO 63401-1257
Phone (573) 248-5460

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
100524GAMDRegistered Nurse
ME168650FLMDNeurology Physician
01092448AINMDNeurology Physician
2023010521MOMDNeurology Physician
70388TNMDNeurology Physician
84278WIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System Inc CurrentSince Sep 20, 2025 Accepting new patients
SSM Regional Health Services CurrentSince Apr 20, 2025 Accepting new patients
Forrest County General Hospital CurrentSince Jan 28, 2025 Accepting new patients
Riverside Physician Services Inc CurrentSince Jun 3, 2024 Accepting new patients
Singing River Health System CurrentSince Nov 1, 2024 Accepting new patients
Forest General Dba Highland Community Hospital CurrentSince Jan 28, 2025 Accepting new patients
North Oaks Medical Center, LLC Current Accepting new patients
Wellmont Medical Associates Inc CurrentSince May 14, 2024 Accepting new patients
Wyoming County CurrentSince Mar 1, 2025 Accepting new patients
Wakemed CurrentSince Oct 13, 2024 Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
Franciscan Physician Network CurrentSince Mar 12, 2025 Accepting new patients
Walthall General Hospital CurrentSince Jan 28, 2025 Accepting new patients
Walthall General Hospital CurrentSince Jan 28, 2025 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince May 14, 2024 Accepting new patients
Hendricks County Hospital Neurology CurrentSince Jul 15, 2024 Accepting new patients
Forrest County General Hospital Current Accepting new patients
Wyoming County CurrentSince Mar 1, 2025 Accepting new patients
North Atlanta Professional Services LLC CurrentSince Jun 17, 2025 Accepting new patients
Riverside Health System CurrentSince Jul 29, 2025 Accepting new patients
Agnesian Healthcare Inc CurrentSince Mar 1, 2026 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 6, 2025 Accepting new patients
The Monroe Clinic, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Wyoming County Current Accepting new patients
Riverside Health System CurrentSince Jul 29, 2025 Accepting new patients
Vidant Medical Group LLC CurrentSince Dec 9, 2024 Accepting new patients
Hendricks County Hospital Current Accepting new patients
Hendricks County Hospital CurrentSince Jul 15, 2024 Accepting new patients
SSM Regional Health Services Current Accepting new patients
Centra Medical Group, LLC CurrentSince Oct 7, 2024 Accepting new patients
Freeman-Oak Hill Health System Neurology CurrentSince Apr 17, 2024 Accepting new patients
Riverside Physician Services Inc CurrentSince Jun 3, 2024 Accepting new patients
Agnesian Healthcare Inc CurrentSince Mar 1, 2026 Accepting new patients
The Monroe Clinic, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Westchester Medical Center Advanced Physician Services PC CurrentSince May 15, 2018 Accepting new patients
Wellmont Health System Current Accepting new patients
Wakemed CurrentSince Oct 13, 2024 Accepting new patients
Wellmont Medical Associates Inc CurrentSince May 14, 2024 Accepting new patients
Wyoming County Current Accepting new patients
Mid Hudson Physicians, P.C. CurrentSince Mar 19, 2018 Accepting new patients
Freeman-Oak Hill Health System CurrentSince Apr 24, 2024 Accepting new patients
Westchester Medical Center Advanced Physician Services, PC Current Accepting new patients
SSM Regional Health Services CurrentSince Apr 20, 2025 Accepting new patients
North Oaks Medical Center, LLC CurrentSince Jun 1, 2025 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Nov 6, 2025 Accepting new patients
Franciscan Physician Network CurrentSince Mar 12, 2025 Accepting new patients
Hendricks County Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients
Nysarc Inc. Ulster, Greene, Putnam Counties Chapter PastSince Oct 12, 2015 Accepting new patients
Hudson Valley Health Specialties, Inc Past Accepting new patients
Mid-Hudson Family Health Institute Past Accepting new patients

Locations (25 of 65)

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000

7655 Solutions Ctr
Chicago, IL 60677

105 S First St
Wilmington, IL 60481
Phone (815) 476-5210

301 Satori Pkwy
Ste 150
Avon, IN 46123
Phone (317) 272-3662

8244 E US Highway 36
Ste 1100
Avon, IN 46123
Phone (317) 272-7500

8244 E US Highway 36
Ste 1340
Avon, IN 46123
Phone (317) 520-5510

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1701 S Creasy Ln
Lafayette, IN 47905
Phone (765) 502-4400

1100 Southfield Dr
Ste 1370
Plainfield, IN 46168
Phone (317) 837-5570

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

15790 Paul Vega Md Dr
Hammond, LA 70403
Phone (985) 230-1682

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

6000 Hospital Dr
#1257
Hannibal, MO 63401
Phone (573) 248-5460

1102 W 32nd St
Joplin, MO 64804
Phone (417) 347-1078

307 W 11th St
Lamar, MO 64759
Phone (417) 682-3300

2101 Highway 90
Gautier, MS 39553
Phone (228) 497-7576

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

3603 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 762-3000

100 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-0455

1900 Kildaire Farm Rd
Cary, NC 27518
Phone (919) 350-2300

10905 Providence Rd W
Ste G200
Charlotte, NC 28277
Phone (980) 488-4900

1901 Randolph Rd
Charlotte, NC 28207
Phone (704) 316-2000

1918 Randolph Rd
Ste 400
Charlotte, NC 28207
Phone (704) 384-9437

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602
  • FHIR API: https://sehproxy.stelizabeth.com/arr-fhir/api/FHIR/R4
  • Direct secure messaging: mkhan431580@balladhealth.medalliesdirect.net

Organizations & group practices 53

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

View all 53

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1861489601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117945151",
            "telephone_number": "631-444-8118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Med Tech Pkwy",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042277",
            "country_code": "US",
            "telephone_number": "423-302-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "127 Health Care Dr Ste 3",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242772853",
            "country_code": "US",
            "telephone_number": "423-230-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Johnson Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421606",
            "country_code": "US",
            "telephone_number": "404-851-8000",
            "fax_number": "404-303-3759",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 S Creasy Ln",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479054972",
            "country_code": "US",
            "telephone_number": "765-502-4400",
            "fax_number": "765-502-4401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12200 Warwick Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236012344",
            "country_code": "US",
            "telephone_number": "757-534-5100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1990 Holton Ave E",
            "address_purpose": "LOCATION",
            "city": "Big Stone Gap",
            "state": "VA",
            "postal_code": "242193350",
            "country_code": "US",
            "telephone_number": "423-230-8200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brookside Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604627",
            "country_code": "US",
            "telephone_number": "423-857-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12200 Warwick Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236012344",
            "country_code": "US",
            "telephone_number": "757-534-5100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16000 Johnston Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117664",
            "country_code": "US",
            "telephone_number": "276-258-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376207430",
            "country_code": "US",
            "telephone_number": "423-844-1121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 S Shady St",
            "address_purpose": "LOCATION",
            "city": "Mountain City",
            "state": "TN",
            "postal_code": "376832021",
            "country_code": "US",
            "telephone_number": "423-727-1100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2030 Temple Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Erwin",
            "state": "TN",
            "postal_code": "376508721",
            "country_code": "US",
            "telephone_number": "423-743-3141",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 W Elk Ave",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432874",
            "country_code": "US",
            "telephone_number": "423-542-1300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 N State Of Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046035",
            "country_code": "US",
            "telephone_number": "423-323-6900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Tusculum Blvd",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377454279",
            "country_code": "US",
            "telephone_number": "423-787-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "365 Broadway",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124015151",
            "country_code": "US",
            "telephone_number": "845-331-5165 x113",
            "fax_number": "845-331-6238",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "515 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "WI",
            "postal_code": "535661569",
            "country_code": "US",
            "telephone_number": "608-324-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 New Bern Ave",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101231",
            "country_code": "US",
            "telephone_number": "919-350-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1519 Main St",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378693657",
            "country_code": "US",
            "telephone_number": "423-733-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "851 Locust St",
            "address_purpose": "LOCATION",
            "city": "Rogersville",
            "state": "TN",
            "postal_code": "378572407",
            "country_code": "US",
            "telephone_number": "423-921-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1102 W 32nd St",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648043503",
            "country_code": "US",
            "telephone_number": "417-347-4570",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "312 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Clintwood",
            "state": "VA",
            "postal_code": "242286786",
            "country_code": "US",
            "telephone_number": "276-926-0300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "58 Carroll St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "VA",
            "postal_code": "242664510",
            "country_code": "US",
            "telephone_number": "276-883-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 15th St NW",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242731616",
            "country_code": "US",
            "telephone_number": "423-630-7001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "245 Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "VA",
            "postal_code": "243541100",
            "country_code": "US",
            "telephone_number": "276-378-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6000 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Hannibal",
            "state": "MO",
            "postal_code": "634016887",
            "country_code": "US",
            "telephone_number": "573-248-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MUSTAFA",
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        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
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}

Other providers in Stony Brook, NY

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