Healthcare Provider Details

I. General information

NPI: 1669826202
Provider Name (Legal Business Name): SAMIHA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST PPE 203
TOWSON MD
21204-6800
US

IV. Provider business mailing address

6565 N CHARLES ST PPE 203
TOWSON MD
21204-6800
US

V. Phone/Fax

Practice location:
  • Phone: 240-338-8050
  • Fax:
Mailing address:
  • Phone: 240-338-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD87770
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0087770
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: