Individual
DR. DASTAGIR ALAM KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27 DYKE RD, LATHAM, NY 12110-1237
(904) 955-7190
Mailing address
27 DYKE RD, LATHAM, NY 12110-1237
(904) 955-7190
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
281049
NY
208M00000X
Hospitalist Physician
281049
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04290768
—
NY
05
—
270290800
—
FL
Enumeration date
11/17/2005
Last updated
01/17/2022
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