Provider Demographics
NPI:1407894140
Name:ALI KHAN, ABEDA (MD)
Entity Type:Individual
Prefix:
First Name:ABEDA
Middle Name:
Last Name:ALI KHAN
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 1:8118 BROOKWOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-9658
Mailing Address - Country:US
Mailing Address - Phone:301-725-1393
Mailing Address - Fax:
Practice Address - Street 1:10820 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-730-9526
Practice Address - Fax:410-730-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF72892Medicare UPIN
MDKH719313Medicare ID - Type Unspecified
MD523RMedicare ID - Type Unspecified