Healthcare Provider Details

I. General information

NPI: 1215253935
Provider Name (Legal Business Name): KHAN PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN ST KHAN PEDIATRICS INC.
ELKTON MD
21921-5906
US

IV. Provider business mailing address

103 E MAIN ST KHAN PEDIATRICS INC.
ELKTON MD
21921-5906
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-5791
  • Fax: 302-449-5794
Mailing address:
  • Phone: 302-449-5791
  • Fax: 302-449-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD ALI KHAN
Title or Position: SOLE PROPRIETOR
Credential: MD, PH.D, FAAP
Phone: 302-449-5791