Provider Demographics
NPI:1659337723
Name:KHWAJA, RAZAULLAH (MD)
Entity Type:Individual
Prefix:
First Name:RAZAULLAH
Middle Name:
Last Name:KHWAJA
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21922-0190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 COLONIAL WAY
Practice Address - Street 2:SUITE B
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2283
Practice Address - Country:US
Practice Address - Phone:410-658-8420
Practice Address - Fax:410-658-4842
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38804208600000X
PAMD0388251208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB35335Medicare UPIN
MD4727Medicare ID - Type Unspecified
PA086015Medicare PIN
MD4727Medicare PIN