Healthcare Provider Details

I. General information

NPI: 1457761728
Provider Name (Legal Business Name): TASLEEMA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S PACA ST
BALTIMORE MD
21201-1642
US

IV. Provider business mailing address

250 W PRATT ST STE 900
BALTIMORE MD
21201-6808
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-1070
  • Fax:
Mailing address:
  • Phone: 814-222-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0090158
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberD0090158
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberD90158
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: