Provider Demographics
NPI:1073527339
Name:REHMAN, KHAWAJA A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHAWAJA
Middle Name:A
Last Name:REHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 ROOSEVELT DR UNIT 112
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3563
Mailing Address - Country:US
Mailing Address - Phone:304-539-3638
Mailing Address - Fax:
Practice Address - Street 1:107 ASSEMBLY DR
Practice Address - Street 2:UNIT 112
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5419
Practice Address - Country:US
Practice Address - Phone:304-539-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21646207R00000X
NC2010-01883207R00000X
TXU2001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE7330961Medicare PIN
RE4140976Medicare PIN
P00824158Medicare PIN