Healthcare Provider Details

I. General information

NPI: 1316969256
Provider Name (Legal Business Name): MUKUL KHANDELWAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KINDRED WAY SUITE 201
GLEN BURNIE MD
21061-5249
US

IV. Provider business mailing address

PO BOX 8416
ELKRIDGE MD
21075-7500
US

V. Phone/Fax

Practice location:
  • Phone: 410-590-8920
  • Fax: 410-799-9331
Mailing address:
  • Phone: 410-590-8920
  • Fax: 410-553-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0052387
License Number StateMD

VIII. Authorized Official

Name: MUKUL KHANDELWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 410-590-8920