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General NPI Number Information
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NPI Number | 1093155475
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Entity Type | Individual
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Provider Name | AYESHA HASAN KHAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 14201 LAUREL PARK DR STE 215
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City | LAUREL
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State | MD
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Zip | 20707-5260
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Country | US
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Telephone | 240-690-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 19328 ERIN TREE CT
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City | GAITHERSBURG
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State | MD
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Zip | 20879-4973
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5101020462
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | H0088396
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License Number State | MD
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