Healthcare Provider Details

I. General information

NPI: 1356319487
Provider Name (Legal Business Name): KHURRAM HANIF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 COLUMBIA 100 PKWY SUITE 316
COLUMBIA MD
21045-2374
US

IV. Provider business mailing address

PO BOX 6004
ELLICOTT CITY MD
21042-0004
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-1234
  • Fax: 410-884-3001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD21996
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: