Individual
DR. SHISHIR KUMAR KHETAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 SEVEN LOCKS RD, STE 111, ROCKVILLE, MD 20854-2957
(301) 762-5020
(301) 294-7569
Mailing address
PO BOX 79632, BALTIMORE, MD 21279-0632
(301) 762-5020
(301) 309-3783
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
73702
CT
207R00000X
Internal Medicine Physician
D0061630
MD
207R00000X
Internal Medicine Physician
ME148198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
416410500
—
MD
01
—
PENDING
MEDICARE HF
FL
Enumeration date
06/21/2005
Last updated
08/19/2025
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