Provider Demographics
NPI:1952119208
Name:MAHWISH KHURRAM MDPA
Entity type:Organization
Organization Name:MAHWISH KHURRAM MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHWISH
Authorized Official - Middle Name:SHAKIL
Authorized Official - Last Name:KHURRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-979-4194
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD STE 204
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4333
Practice Address - Country:US
Practice Address - Phone:410-687-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty