Provider Demographics
NPI:1447281308
Name:FAROOQ, KHAWAJA A (MD)
Entity type:Individual
Prefix:DR
First Name:KHAWAJA
Middle Name:A
Last Name:FAROOQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6482
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PARKWAY
Practice Address - Street 2:ACUTE CARE PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-1687
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064651207R00000X
MDD64651207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
145724700OtherDEPT OF LABOR
MD410955400Medicaid
6341083OtherAETNA HMO
7577873OtherAETNA PPO
MDS1380114OtherCAREFIRST REGIONAL GBMC
MDF551/603019-01OtherCAREFIRST BWMC
MDKJ15/89140401OtherCAREFIRST OF MARYLAND GBM
89140405OtherCAREFIRST
S3990062OtherCAREFIRST
MDKJ15/89140401OtherCAREFIRST OF MARYLAND GBM
MD725LP858Medicare PIN
6341083OtherAETNA HMO
136643ZADNMedicare PIN
145724700OtherDEPT OF LABOR
S3990062OtherCAREFIRST