=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538121363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMILLE Y KHAWAND PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 PINE BLUFF RD SUITE 7A
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-7160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-749-8370
-----------------------------------------------------
Fax | 410-749-8910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 PINE BLUFF RD SUITE 7A
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-7160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-749-8370
-----------------------------------------------------
Fax | 410-749-8910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CAMILLE Y KHAWAND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-749-8370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | D0053452
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------