Provider Demographics
NPI:1144752908
Name:KHAN, MARYAM (MD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1205 YORK RD STE 11
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6211
Mailing Address - Country:US
Mailing Address - Phone:443-577-4010
Mailing Address - Fax:443-577-4010
Practice Address - Street 1:1205 YORK RD STE 11
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6211
Practice Address - Country:US
Practice Address - Phone:443-577-4010
Practice Address - Fax:443-577-4010
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0088409207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine