Provider Demographics
NPI:1235112905
Name:KHANDAGLE, LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:KHANDAGLE
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:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-2735
Mailing Address - Country:US
Mailing Address - Phone:301-439-1200
Mailing Address - Fax:301-439-5883
Practice Address - Street 1:831 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 25
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2916
Practice Address - Country:US
Practice Address - Phone:301-439-1200
Practice Address - Fax:301-439-5883
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI08464Medicare UPIN
MDG01727K02Medicare ID - Type Unspecified