MEDICARE: DR. LAURA KHANDAGLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D61067	MD

General Provider Information

NPI Number	:	1235112905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA KHANDAGLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2735
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20709-2735
Country	:	US
Telephone Number	:	301-439-1200
Fax Number	:	301-439-5883

Provider Business Practice Location Address
First Line	:	831 UNIVERSITY BLVD E
Second Line	:	SUITE 25
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2916
Country	:	US
Telephone Number	:	301-439-1200
Fax Number	:	301-439-5883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2005
Last Update Date	:	07/08/2007

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