Provider Demographics
NPI:1801847736
Name:KHANJAR, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:KHANJAR
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 1040
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6435
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:
Practice Address - Street 1:300 E PULASKI HWY
Practice Address - Street 2:SUITE 112
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6435
Practice Address - Country:US
Practice Address - Phone:410-392-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306640207V00000X
MDD0055137207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00216349OtherMEDICARE RAILROAD
MD603202800Medicaid
MDH02788Medicare UPIN
MD149L220ZMedicare ID - Type Unspecified
MD875M637FMedicare PIN