Provider Demographics
NPI:1598187148
Name:AHMAD KHAN MD LLC
Entity Type:Organization
Organization Name:AHMAD KHAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-310-7594
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-0077
Mailing Address - Country:US
Mailing Address - Phone:443-896-4920
Mailing Address - Fax:443-576-4484
Practice Address - Street 1:10715 CHARTER DR
Practice Address - Street 2:SUITE 270
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2882
Practice Address - Country:US
Practice Address - Phone:443-896-4920
Practice Address - Fax:443-576-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00560662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD978301600Medicaid