Provider Demographics
NPI:1386795573
Name:SHAMSUZZOHA, KHONDKER M (MD)
Entity type:Individual
Prefix:DR
First Name:KHONDKER
Middle Name:M
Last Name:SHAMSUZZOHA
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 1:6567 FORSYTHIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1167
Mailing Address - Country:US
Mailing Address - Phone:703-822-0845
Mailing Address - Fax:
Practice Address - Street 1:196 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE # 215
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4397
Practice Address - Country:US
Practice Address - Phone:301-668-9988
Practice Address - Fax:301-668-9977
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 0057162207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050085552OtherMEDICARE RAILROAD
MD754401400Medicaid
050085552OtherMEDICARE RAILROAD
MDH 50566Medicare UPIN
MD702LC213Medicare PIN