Healthcare Provider Details

I. General information

NPI: 1760506950
Provider Name (Legal Business Name): ALLERGY & ASTHMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TOLL HOUSE AVE BLDG E
FREDERICK MD
21701-4564
US

IV. Provider business mailing address

801 TOLL HOUSE AVE BLDG E
FREDERICK MD
21701-4564
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-4935
  • Fax:
Mailing address:
  • Phone: 301-694-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD0023240
License Number StateMD

VIII. Authorized Official

Name: DR. HIDAYAT KHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-694-4935