Healthcare Provider Details

I. General information

NPI: 1154353027
Provider Name (Legal Business Name): JAHANGIR M. KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 PHILADELPHIA RD SUITE 304
BALTIMORE MD
21237-4317
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-687-7010
  • Fax: 410-687-8095
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD22503
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: