1538121363 NPI number — CAMILLE Y KHAWAND PA

Table of content: DR. JAY GRAHAM JAMISON MD (NPI 1073359972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538121363 NPI number — CAMILLE Y KHAWAND PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMILLE Y KHAWAND PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538121363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 PINE BLUFF RD
Provider Second Line Business Mailing Address:
SUITE 7A
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-7160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-8370
Provider Business Mailing Address Fax Number:
410-749-8910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 PINE BLUFF RD
Provider Second Line Business Practice Location Address:
SUITE 7A
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-7160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-8370
Provider Business Practice Location Address Fax Number:
410-749-8910
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHAWAND
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-749-8370

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  D0053452 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 254QCA . This is a "BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G2250001 . This is a "BCBS DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0001142701 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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