Provider Demographics
NPI:1669416160
Name:KHAN, EJAZ M (MD)
Entity type:Individual
Prefix:DR
First Name:EJAZ
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 WATKINS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1628
Mailing Address - Country:US
Mailing Address - Phone:301-350-8500
Mailing Address - Fax:540-350-8503
Practice Address - Street 1:20 WATKINS PARK DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1628
Practice Address - Country:US
Practice Address - Phone:301-350-8500
Practice Address - Fax:540-350-8503
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239751207RC0001X
NJ25MA09948900207RC0001X
MDD0092421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010077Medicaid
VA1669416160Medicaid
VA00X527W01Medicare PIN
WV3810010077Medicaid