Provider Demographics
NPI:1255942231
Name:KHADEJA FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:KHADEJA FAMILY PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KHADEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-275-6765
Mailing Address - Street 1:4843 MARSDEN PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6822
Mailing Address - Country:US
Mailing Address - Phone:240-439-5619
Mailing Address - Fax:240-597-1196
Practice Address - Street 1:5 HILLCREST DR STE B103
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6115
Practice Address - Country:US
Practice Address - Phone:571-275-6765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty