Provider Demographics
NPI:1487611059
Name:KHAN, MOHAMMAD ALI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7741 BELLE POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-345-3152
Mailing Address - Fax:301-345-3182
Practice Address - Street 1:7741 BELLE POINT DRIVE
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-345-3152
Practice Address - Fax:301-345-3182
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023242208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187402100Medicaid
D09620Medicare UPIN
439882Medicare ID - Type Unspecified