Provider Demographics
NPI:1508849274
Name:KHANDAGLE, KENNETH F (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:F
Last Name:KHANDAGLE
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 265
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-0265
Mailing Address - Country:US
Mailing Address - Phone:301-439-1200
Mailing Address - Fax:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-27
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0015300 00Medicaid
MDI08465Medicare UPIN