Provider Demographics
NPI:1881677557
Name:KHANDAGLE MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:KHANDAGLE MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KHANDAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-439-1200
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20709-2735
Mailing Address - Country:US
Mailing Address - Phone:301-439-1200
Mailing Address - Fax:301-439-5883
Practice Address - Street 1:831 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 25
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2916
Practice Address - Country:US
Practice Address - Phone:301-439-1200
Practice Address - Fax:301-439-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI08465Medicare UPIN
MDG01727K02Medicare ID - Type UnspecifiedLAURA KHANDAGLE, M.D.
MDI08464Medicare UPIN
MDG01727K01Medicare ID - Type UnspecifiedKENNETH KHANDAGLE, M.D.
MDG01727Medicare ID - Type UnspecifiedGROUP #