Individual provider Active NPI

Sidrah Khan, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Wilkes-Barre, PA
National Provider Identifier
1871345330
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
Geisinger Wyoming Valley Medical Center
100 East Mountain Blvd
Wilkes-Barre, PA 18711-0001
Phone
(570) 808-3746
Fax
(570) 808-5967
NPI assigned
Apr 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

Geisinger Wyoming Valley Medical Center
100 East Mountain Blvd
Wilkes-Barre, PA 18711-0001

Mailing address

Geisinger Wyoming Valley Medical Center
100 East Mountain Blvd
Wilkes-Barre, PA 18711-0001
Phone (570) 808-3746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20240829001393 PA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 2860931250

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1871345330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "GEISINGER WYOMING VALLEY MEDICAL CENTER",
            "address_2": "100 EAST MOUNTAIN BLVD",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "187110001",
            "telephone_number": "570-808-3746",
            "fax_number": "570-808-5967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GEISINGER WYOMING VALLEY MEDICAL CENTER",
            "address_2": "100 EAST MOUNTAIN BLVD",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "187110001",
            "telephone_number": "570-808-3746",
            "fax_number": "570-808-5967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SIDRAH",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes-Barre, PA

Sources for this page

Verify at the official NPI Registry.