Provider Demographics
NPI:1801813746
Name:KHETERPAL, PANKAJ (MD)
Entity type:Individual
Prefix:
First Name:PANKAJ
Middle Name:
Last Name:KHETERPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20 HICKORY KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4745
Mailing Address - Country:US
Mailing Address - Phone:410-687-8818
Mailing Address - Fax:410-682-3989
Practice Address - Street 1:120 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-7020
Practice Address - Country:US
Practice Address - Phone:410-687-8818
Practice Address - Fax:410-682-3989
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0060560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1801813746OtherBRAVO HEALTH
DCN681-0001OtherCAREFIRST
SC300443355001OtherHEALTHNET FEDERAL SERVICES - TRICARE
GAP00693651OtherRAILROAD MEDICARE
PA1026359400001OtherMEDICAL ASSISTANCE
MD618SZBQKOtherMEDICARE
MD402778700OtherMEDICAL ASSISTANCE
GAP00693651OtherRAILROAD MEDICARE
MD618SZBQKOtherMEDICARE
MD1801813746OtherBRAVO HEALTH