Healthcare Provider Details

I. General information

NPI: 1174752760
Provider Name (Legal Business Name): FATIMA TABASSUM KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

9019 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

V. Phone/Fax

Practice location:
  • Phone: 240-720-1527
  • Fax: 240-332-4589
Mailing address:
  • Phone: 240-720-1527
  • Fax: 240-332-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD74622
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: