Provider Demographics
NPI:1457328627
Name:KHAN, KAUSER FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:KAUSER
Middle Name:FATIMA
Last Name: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 1:2 W ROLLING CROSSROADS
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6208
Mailing Address - Country:US
Mailing Address - Phone:410-455-9894
Mailing Address - Fax:410-455-9846
Practice Address - Street 1:2 W ROLLING CROSSROADS
Practice Address - Street 2:SUITE # 106
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6208
Practice Address - Country:US
Practice Address - Phone:410-455-9894
Practice Address - Fax:410-455-9846
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD58608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400127300Medicaid