Provider Demographics
NPI:1902162530
Name:GEORGE KHACHAN, M.D., P.A.
Entity Type:Organization
Organization Name:GEORGE KHACHAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-724-1151
Mailing Address - Street 1:625 KENT AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3794
Mailing Address - Country:US
Mailing Address - Phone:301-724-1151
Mailing Address - Fax:301-724-1894
Practice Address - Street 1:625 KENT AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3794
Practice Address - Country:US
Practice Address - Phone:301-724-1151
Practice Address - Fax:301-724-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD069751600Medicaid
MD531MMedicare PIN