Provider Demographics
NPI:1669437364
Name:KHANDELWAL, BASANT K (MD)
Entity type:Individual
Prefix:DR
First Name:BASANT
Middle Name:K
Last Name:KHANDELWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1600 CRAIN HWY S
Mailing Address - Street 2:STE. 201
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5577
Mailing Address - Country:US
Mailing Address - Phone:410-707-8007
Mailing Address - Fax:410-766-8677
Practice Address - Street 1:1600 CRAIN HIGHWAY
Practice Address - Street 2:STE. 201
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-761-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023624207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB67107Medicare UPIN
MD034M787EMedicare ID - Type UnspecifiedBASANT KHANDELWAL, M.D.
MDKK38846XMedicare ID - Type UnspecifiedBASANT K. KHANDELWAL, M.D