Provider Demographics
NPI:1356319487
Name:HANIF, KHURRAM (MD)
Entity Type:Individual
Prefix:
First Name:KHURRAM
Middle Name:
Last Name:HANIF
Suffix:
Gender:M
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 6004
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-0004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 316
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2374
Practice Address - Country:US
Practice Address - Phone:410-884-1234
Practice Address - Fax:410-884-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21996207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4003Medicare PIN