Provider Demographics
NPI:1295913838
Name:AWAN, KHADIJA (MD)
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:
Last Name:AWAN
Suffix:
Gender:F
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:P.O.BOX 1040
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-1040
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:410-392-9408
Practice Address - Street 1:300 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6435
Practice Address - Country:US
Practice Address - Phone:410-398-0590
Practice Address - Fax:410-392-9408
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191451207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology