Provider Demographics
NPI:1538121363
Name:CAMILLE Y KHAWAND PA
Entity Type:Organization
Organization Name:CAMILLE Y KHAWAND PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KHAWAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-749-8370
Mailing Address - Street 1:105 PINE BLUFF RD
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7160
Mailing Address - Country:US
Mailing Address - Phone:410-749-8370
Mailing Address - Fax:410-749-8910
Practice Address - Street 1:105 PINE BLUFF RD
Practice Address - Street 2:SUITE 7A
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7160
Practice Address - Country:US
Practice Address - Phone:410-749-8370
Practice Address - Fax:410-749-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053452207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD254QCAOtherBCBS MD
DCG2250001OtherBCBS DC
DE0001142701Medicaid
DE0001142701Medicaid
MD128M054FMedicare PIN