Healthcare Provider Details

I. General information

NPI: 1083174668
Provider Name (Legal Business Name): AFZAL AHMAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL AVE
WESTMINSTER MD
21157-5726
US

IV. Provider business mailing address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-2300
  • Fax: 240-686-2330
Mailing address:
  • Phone: 352-333-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0094925
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: