Provider Demographics
NPI:1992998595
Name:ABEDA ALI KHAN, MD PA
Entity type:Organization
Organization Name:ABEDA ALI KHAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-730-9526
Mailing Address - Street 1:8118 BROOKWOOD FARM RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-9658
Mailing Address - Country:US
Mailing Address - Phone:410-730-9526
Mailing Address - Fax:
Practice Address - Street 1:10820 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-730-9526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF72892Medicare UPIN