Healthcare Provider Details

I. General information

NPI: 1922088566
Provider Name (Legal Business Name): CAMILLE Y KHAWAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PINE BLUFF RD SUITE 7A
SALISBURY MD
21801-7160
US

IV. Provider business mailing address

105 PINE BLUFF RD SUITE 7A
SALISBURY MD
21801-7160
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-8370
  • Fax: 410-749-8910
Mailing address:
  • Phone: 410-749-8370
  • Fax: 410-749-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0053452
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: