Provider Demographics
NPI:1871699306
Name:KHAN, RESHMA (MD)
Entity type:Individual
Prefix:MRS
First Name:RESHMA
Middle Name:
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 1:11007 ABBEY STATION LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4574
Mailing Address - Country:US
Mailing Address - Phone:301-593-4589
Mailing Address - Fax:
Practice Address - Street 1:11016 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2602
Practice Address - Country:US
Practice Address - Phone:301-681-3300
Practice Address - Fax:301-681-4777
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD019261W94Medicare ID - Type Unspecified
MDH98983Medicare UPIN