Healthcare Provider Details

I. General information

NPI: 1538213384
Provider Name (Legal Business Name): ATIYA BATOOL KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14333 LAUREL BOWIE ROAD SUITE 303
LAUREL MD
20708
US

IV. Provider business mailing address

14333 LAUREL BOWIE ROAD SUITE 303
LAUREL MD
20708
US

V. Phone/Fax

Practice location:
  • Phone: 301-725-4334
  • Fax: 301-725-8073
Mailing address:
  • Phone: 301-725-4334
  • Fax: 301-725-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0023239
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: