Provider Demographics
NPI:1922569755
Name:KHAN, FAHAD SAEED
Entity type:Individual
Prefix:
First Name:FAHAD
Middle Name:SAEED
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3150
Mailing Address - Country:US
Mailing Address - Phone:301-877-4540
Mailing Address - Fax:301-856-3470
Practice Address - Street 1:10401 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3150
Practice Address - Country:US
Practice Address - Phone:301-877-4540
Practice Address - Fax:301-856-3470
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDH01010752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program