Healthcare Provider Details

I. General information

NPI: 1770824195
Provider Name (Legal Business Name): MD IMMEDIATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LEWIS ST
HAVRE DE GRACE MD
21078-3420
US

IV. Provider business mailing address

504 LEWIS ST
HAVRE DE GRACE MD
21078-3420
US

V. Phone/Fax

Practice location:
  • Phone: 443-502-5311
  • Fax: 443-955-5736
Mailing address:
  • Phone: 443-502-5311
  • Fax: 443-955-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. REHAN KHAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 443-243-8894