Provider Demographics
NPI:1538120613
Name:KHAN, AHMAD NAWAZ (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:NAWAZ
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-0077
Mailing Address - Country:US
Mailing Address - Phone:410-310-7594
Mailing Address - Fax:443-542-0870
Practice Address - Street 1:3355 ST JOHN'S LANE
Practice Address - Street 2:SUITE F
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7148
Practice Address - Country:US
Practice Address - Phone:410-310-7594
Practice Address - Fax:443-542-0870
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00560662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD978301600Medicaid
520RMedicare ID - Type Unspecified
MD978301600Medicaid
184P424GMedicare ID - Type Unspecified