Provider Demographics
NPI:1114100583
Name:KHAN, SHALLA H (MD)
Entity Type:Individual
Prefix:DR
First Name:SHALLA
Middle Name:H
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:849 QUINCE ORCHARD BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1678
Mailing Address - Country:US
Mailing Address - Phone:301-527-9464
Mailing Address - Fax:301-527-9423
Practice Address - Street 1:849 QUINCE ORCHARD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1678
Practice Address - Country:US
Practice Address - Phone:301-527-9464
Practice Address - Fax:301-527-9423
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42194207K00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF40435Medicare UPIN
MDKH149649Medicare PIN