Basic Information
Provider Information
NPI: 1912404054
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KHAN
FirstName: ONEIB
MiddleName: U.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 64442
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212644442
CountryCode: US
TelephoneNumber: 4103288040
FaxNumber: 4434623514
Practice Location
Address1: 22 S GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011590
CountryCode: US
TelephoneNumber: 4103287604
FaxNumber: 4103287607
Other Information
ProviderEnumerationDate: 04/06/2018
LastUpdateDate: 10/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XD91666MDN Allopathic & Osteopathic PhysiciansHospitalist 
207RC0000XD91666MDY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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