Provider Demographics
NPI:1376153726
Name:DR. KATTIE KHADAR, PC
Entity Type:Organization
Organization Name:DR. KATTIE KHADAR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADAR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-FNP
Authorized Official - Phone:240-481-5289
Mailing Address - Street 1:6201 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2354
Mailing Address - Country:US
Mailing Address - Phone:301-547-3939
Mailing Address - Fax:
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-547-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1740763093OtherNPI