Provider Demographics
NPI:1538213384
Name:KHAN, ATIYA BATOOL (MD)
Entity type:Individual
Prefix:
First Name:ATIYA
Middle Name:BATOOL
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14333 LAUREL BOWIE ROAD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-725-4334
Mailing Address - Fax:301-725-8073
Practice Address - Street 1:14333 LAUREL BOWIE ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:301-725-4334
Practice Address - Fax:301-725-8073
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023239208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics