Provider Demographics
NPI:1164526364
Name:AWAN, KHALID J (MD)
Entity Type:Individual
Prefix:MR
First Name:KHALID
Middle Name:J
Last Name:AWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1921 PARK AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273
Mailing Address - Country:US
Mailing Address - Phone:276-679-4567
Mailing Address - Fax:276-679-5736
Practice Address - Street 1:1921 PARK AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-679-4567
Practice Address - Fax:276-679-5736
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021992207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1458222OtherUMWA
TN0102OtherJOHN DEERE
VA288838OtherANTHEM
181888586OtherRAILROAD MEDICARE
7102000OtherBCBS MICHIGAN
8786OtherANCTRY KY
006895400OtherFEDERAL BLACK LUNG
223599700OtherUS FORESTRY SERVICE
5393077OtherAETNA
0654040001Medicare NSC
181888586OtherRAILROAD MEDICARE
8786OtherANCTRY KY