Healthcare Provider Details

I. General information

NPI: 1235112905
Provider Name (Legal Business Name): LAURA KHANDAGLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 UNIVERSITY BLVD E SUITE 25
SILVER SPRING MD
20903-2916
US

IV. Provider business mailing address

PO BOX 2735
LAUREL MD
20709-2735
US

V. Phone/Fax

Practice location:
  • Phone: 301-439-1200
  • Fax: 301-439-5883
Mailing address:
  • Phone: 301-439-1200
  • Fax: 301-439-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD61067
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: