Individual provider Active NPI

Maria Khan

  • Clinical Child & Adolescent Psychologist
  • Baltimore, MD
National Provider Identifier
1366118960
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Practice address
1740 Ashland Ave
Baltimore, MD 21205-1529
Phone
(248) 417-5011
NPI assigned
Aug 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X Primary

Addresses

Primary practice location

1740 Ashland Ave
Baltimore, MD 21205-1529

Mailing address

2004 E Pratt St Apt 2
Baltimore, MD 21231-1945
Phone (248) 417-5011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220926001428 WV Practitioner - Clinical Psychologist 1658757869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

930 Chestnut Ridge Rd
Morgantown, WV 26505-2807
Phone (304) 598-4214

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Sep 30, 2022 Accepting new patients
West Virginia University Medical Corporation CurrentSince Sep 30, 2022 Accepting new patients
West Virginia University Medical Corporation Current Accepting new patients

Locations

930 Chestnut Ridge Rd
Morgantown, WV 26505
Phone (304) 293-5299

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Interoperability endpoints

  • Direct secure messaging: mkhan336618@direct.wvuhsdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1366118960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 E PRATT ST APT 2",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311945",
            "telephone_number": "248-417-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 ASHLAND AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212051529",
            "telephone_number": "248-417-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MARIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.