Provider Demographics
NPI:1881630424
Name:ZAKRIYA, KHWAJA (MD)
Entity Type:Individual
Prefix:
First Name:KHWAJA
Middle Name:
Last Name:ZAKRIYA
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 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1111 BEARDS HILL ROAD
Practice Address - Street 2:SUITE 700
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2275
Practice Address - Country:US
Practice Address - Phone:410-273-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56141207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD162700700Medicaid
MDKR79B539Medicare ID - Type Unspecified
MD162700700Medicaid
MD359833ZE2NMedicare PIN