Provider Demographics
NPI:1114100583
Name:KHAN, SHALLA H (MD)
Entity type:Individual
Prefix:DR
First Name:SHALLA
Middle Name:H
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 1:19328 ERIN TREE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879
Mailing Address - Country:US
Mailing Address - Phone:240-271-0745
Mailing Address - Fax:301-527-9423
Practice Address - Street 1:604 SOLAREX COURT
Practice Address - Street 2:SUITE 206
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703
Practice Address - Country:US
Practice Address - Phone:301-663-0006
Practice Address - Fax:301-663-0688
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42194207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD148651900Medicaid
MDKH149649Medicare PIN