Basic Information
| Provider Information | |||||||||
| NPI: | 1447281308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAROOQ | ||||||||
| FirstName: | KHAWAJA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816482 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 MEDICAL PARKWAY | ||||||||
| Address2: | ACUTE CARE PAVILION | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
| FaxNumber: | 4434811687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0064651 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D64651 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | D64651 | MD | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 145724700 | 01 | DEPT OF LABOR | OTHER | 410955400 | 05 | MD | MEDICAID | 6341083 | 01 | AETNA HMO | OTHER | 7577873 | 01 | AETNA PPO | OTHER | S1380114 | 01 | MD | CAREFIRST REGIONAL GBMC | OTHER | F551/603019-01 | 01 | MD | CAREFIRST BWMC | OTHER | KJ15/89140401 | 01 | MD | CAREFIRST OF MARYLAND GBM | OTHER | 89140405 | 01 | CAREFIRST | OTHER | S3990062 | 01 | CAREFIRST | OTHER |