Tariq Mahmood Khan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

207469-1 Issued in NY

Practice address

1684 Foote Avenue Ext
Jamestown, NY 14701-9385

Phone

(716) 661-9730

Fax

(716) 661-9732

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Southern Tier Pediatrics Practice, P.C.

  • Pediatric Adolescent Medicine Physician
  • Jamestown, NY
  • NPI 1710902200
  NPD (past) Authorized official

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1922002906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1684 FOOTE AVENUE EXT",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147019385",
            "telephone_number": "716-661-9730",
            "fax_number": "716-661-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 FOOTE AVENUE EXT",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147019385",
            "telephone_number": "716-661-9730",
            "fax_number": "716-661-9732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "TARIQ",
        "middle_name": "MAHMOOD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "207469-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02366347",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH ID",
            "identifier": "1290375",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA/EXCELLUS",
            "identifier": "00021051301",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RMSCO ID",
            "identifier": "00021051301",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01664951",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE CHAUTAUQUA PLAN IDS",
            "identifier": "72679",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELISCARE NEW YORK ID",
            "identifier": "040426036267",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID (COMM INS)",
            "identifier": "161570481",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD WNY",
            "identifier": "000524287002",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stp@348.direct.myezyaccess.com",
            "affiliation": "N",
            "address_1": "1684 Foote Avenue Ext",
            "city": "Jamestown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "147019385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Marie Keeler
• Brooke K Kelly, DO
• Derek Kennedy
• Amanda Rose Kent, PMHNP
• Peggy Sue Kestler, NP
• Kiantone Independent Fire Department, Inc.
• Elizabeth Kidder, MD
• Zachary Taylor Kiendl, DC
• Kim & Sutaria MD PC
• Jin Soo Kim, MD

• Pediatrics Physician in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.