=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679739627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAHANGIR KHAN MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2008
-----------------------------------------------------
Last Update Date | 03/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9114 PHILADELPHIA RD SUITE 304
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21237-4345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-687-7010
-----------------------------------------------------
Fax | 410-687-8095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10845 PHILADELPHIA RD
-----------------------------------------------------
City | WHITE MARSH
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21162-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-335-0008
-----------------------------------------------------
Fax | 410-335-1133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAHANGIR M. KHAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-335-0008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | D0022503
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------