Provider Demographics
NPI:1053463893
Name:KHAN, NADRA N (MD)
Entity Type:Individual
Prefix:
First Name:NADRA
Middle Name:N
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6482
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PARKWAY
Practice Address - Street 2:ACUTE CARE PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-1687
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD65156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD012318800Medicaid
6875055OtherAETNA HMO
89372202OtherCAREFORST MARYLAND
S3990054OtherCAREFIRST/BLUE CHOICE
0039732900OtherFEDERAL BLACK LUNG
7631246OtherAETNA PPO
145724700OtherFEDERAL WRKMAN'S COMP
P00917238Medicare PIN
6875055OtherAETNA HMO