Healthcare Provider Details

I. General information

NPI: 1669588265
Provider Name (Legal Business Name): SARAH HUSSAIN KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST RM N3W143
BALTIMORE MD
21201
US

IV. Provider business mailing address

22 S GREENE ST RM N3W143
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number042-0010506
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: