Provider Demographics
NPI:1073653473
Name:KHAN, IJAZ (MD)
Entity Type:Individual
Prefix:
First Name:IJAZ
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2132 EDGEWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1242
Mailing Address - Country:US
Mailing Address - Phone:301-493-4200
Mailing Address - Fax:301-493-6209
Practice Address - Street 1:6040 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1848
Practice Address - Country:US
Practice Address - Phone:301-493-4200
Practice Address - Fax:301-493-6209
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00315692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF88936Medicare UPIN