Healthcare Provider Details

I. General information

NPI: 1275789430
Provider Name (Legal Business Name): KHANJAN H NAGARSHETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W REDWOOD ST STE 240
BALTIMORE MD
21201-7004
US

IV. Provider business mailing address

22 S GREENE ST STE 10B100
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5840
  • Fax: 410-328-0717
Mailing address:
  • Phone: 410-328-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA09752900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number25MA09752900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA09752900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD446266
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD84537
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: