Provider Demographics
NPI:1851348155
Name:KHAN, IJAZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:IJAZ
Middle Name:A
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 1:5415 OLD COURT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5170
Mailing Address - Country:US
Mailing Address - Phone:410-496-8741
Mailing Address - Fax:410-922-1612
Practice Address - Street 1:5415 OLD COURT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5170
Practice Address - Country:US
Practice Address - Phone:410-496-8741
Practice Address - Fax:410-922-1612
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61013207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621739-01OtherBLUE CROSS/BLUE SHIELD
MDP00084928Medicare PIN
MDG17602Medicare UPIN
DE1000034714Medicaid
MDCG0026Medicare PIN
MDH401Medicare PIN