Healthcare Provider Details

I. General information

NPI: 1114100583
Provider Name (Legal Business Name): SHALLA H KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 03/20/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 SOLAREX COURT SUITE 206
FREDERICK MD
21703
US

IV. Provider business mailing address

19328 ERIN TREE CT
GAITHERSBURG MD
20879
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-0006
  • Fax: 301-663-0688
Mailing address:
  • Phone: 240-271-0745
  • Fax: 301-527-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD42194
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD42194
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: