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General NPI Number Information
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NPI Number | 1164454765
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Entity Type | Individual
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Provider Name | GEORGE KHACHAN M.D.,P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 625 KENT AVE SUITE 301
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City | CUMBERLAND
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State | MD
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Zip | 21502-3794
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Country | US
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Telephone | 301-724-1151
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Fax | 301-724-1894
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Provider Business Mailing Address
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Address Line | 912 BISHOP WALSH RD
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City | CUMBERLAND
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State | MD
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Zip | 21502-1806
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Country | US
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Telephone | 301-724-1151
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Fax | 301-724-1894
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | D38971
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License Number State | MD
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