Provider Demographics
NPI:1063402857
Name:KHAN, KAZI S (MD)
Entity type:Individual
Prefix:DR
First Name:KAZI
Middle Name:S
Last Name:KHAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 SWEETBAY DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1664
Mailing Address - Country:US
Mailing Address - Phone:410-546-4427
Mailing Address - Fax:410-546-2096
Practice Address - Street 1:1821 SWEETBAY DR
Practice Address - Street 2:STE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1664
Practice Address - Country:US
Practice Address - Phone:410-546-4427
Practice Address - Fax:410-546-2096
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053611207RN0300X
MDD53611207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD846200300Medicaid
MDD0053611Medicare UPIN
MDKP95J866Medicare ID - Type Unspecified