Provider Demographics
NPI:1689899361
Name:KHAWAJA, ALI IMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:IMRAN
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17 WESTERN MARYLAND PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5471
Mailing Address - Country:US
Mailing Address - Phone:301-797-6389
Mailing Address - Fax:301-797-4119
Practice Address - Street 1:17 WESTERN MARYLAND PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5471
Practice Address - Country:US
Practice Address - Phone:301-797-6389
Practice Address - Fax:301-797-4119
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068680208100000X, 2081P2900X
PAMD4314862081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6838916OtherAETNA-MD HMO
MD417103900Medicaid
PA6913012OtherAETNA PA HMO
MD9396180OtherAETNA-MD NONHMO
PA1974224OtherHIGHMARK BLUE SHIELD PA LOCATION
MD94954101OtherBLUE SHIELD PPN
PA2092614OtherHIGHMARK BLUE SHIELD MD LOCATION
PA9396180OtherAETNA-PA NONHMO
MDW2660021OtherBLUE SHIELD REGIONAL
PA112953MOTMedicare PIN
PA9396180OtherAETNA-PA NONHMO