Provider Demographics
NPI:1154353027
Name:KHAN, JAHANGIR M (MD)
Entity type:Individual
Prefix:
First Name:JAHANGIR
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-1133
Practice Address - Street 1:9114 PHILADELPHIA RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4317
Practice Address - Country:US
Practice Address - Phone:410-687-7010
Practice Address - Fax:410-687-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22503207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF830JM 32767009OtherCAREFIRST
DCT072 0001OtherCAREFIRST
DCN358 0001OtherCAREFIRST
MD367401100Medicaid
MD5296JM 32767004OtherCAREFIRST
025644OtherE.H.P.
GA110033994OtherRAILROAD MEDICARE
DCT072 0001OtherCAREFIRST
MD5296JM 32767004OtherCAREFIRST