Provider Demographics
NPI:1588676027
Name:KHAN, WAJEED (MD)
Entity Type:Individual
Prefix:DR
First Name:WAJEED
Middle Name:
Last Name:KHAN
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 1:15832 LAUGHLIN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1073
Mailing Address - Country:US
Mailing Address - Phone:301-570-6324
Mailing Address - Fax:
Practice Address - Street 1:12016 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2004
Practice Address - Country:US
Practice Address - Phone:301-942-2105
Practice Address - Fax:301-942-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD356121600Medicaid
MD356121600Medicaid
MDKH411415Medicare ID - Type Unspecified