Provider Demographics
NPI:1467470567
Name:KHAN, AHSAN S (MD)
Entity type:Individual
Prefix:
First Name:AHSAN
Middle Name:S
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 1:1710 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5600
Mailing Address - Country:US
Mailing Address - Phone:410-442-1842
Mailing Address - Fax:410-442-1685
Practice Address - Street 1:1710 WILLOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5600
Practice Address - Country:US
Practice Address - Phone:410-442-1842
Practice Address - Fax:410-442-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72236207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD72236Medicare UPIN
MD4872ASMedicare ID - Type Unspecified