Provider Demographics
NPI:1801813746
Name:KHETERPAL, PANKAJ (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:
Last Name:KHETERPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 IRON MILLL GARTH
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1386
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-391-8565
Practice Address - Street 1:223 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-6936
Practice Address - Country:US
Practice Address - Phone:410-687-8818
Practice Address - Fax:410-682-3989
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026359400001OtherMEDICAL ASSISTANCE
MD1801813746OtherBRAVO HEALTH
MD402778700OtherMEDICAL ASSISTANCE
MD618SZBQKOtherMEDICARE
SC300443355001OtherHEALTHNET FEDERAL SERVICES - TRICARE
GAP00693651OtherRAILROAD MEDICARE
DCN681-0001OtherCAREFIRST
GAP00693651OtherRAILROAD MEDICARE
MD618SZBQKOtherMEDICARE
MD1801813746OtherBRAVO HEALTH