Provider Demographics
NPI:1760625701
Name:KHAN, MAHFUZUL HAQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHFUZUL
Middle Name:HAQUE
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 1:10330 PINEHURST CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2139
Mailing Address - Country:US
Mailing Address - Phone:434-228-0562
Mailing Address - Fax:
Practice Address - Street 1:193 STONER AVE STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5782
Practice Address - Country:US
Practice Address - Phone:410-751-2510
Practice Address - Fax:410-751-2515
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010240984207RE0101X
MDD0068753207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism