Provider Demographics
NPI:1225285117
Name:KHAWAJA, SALMAAN A (PSYD, EDS)
Entity Type:Individual
Prefix:DR
First Name:SALMAAN
Middle Name:A
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:PSYD, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1466
Mailing Address - Country:US
Mailing Address - Phone:804-285-6880
Mailing Address - Fax:804-706-1585
Practice Address - Street 1:11601 IRON BRIDGE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1466
Practice Address - Country:US
Practice Address - Phone:804-285-6880
Practice Address - Fax:804-706-1585
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
VA0810004012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN