Provider Demographics
NPI:1306189816
Name:NASSAR F KHAN MD PC
Entity Type:Organization
Organization Name:NASSAR F KHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASSAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-560-8444
Mailing Address - Street 1:2826 OLD LEE HWY
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4323
Mailing Address - Country:US
Mailing Address - Phone:703-560-8444
Mailing Address - Fax:703-560-4888
Practice Address - Street 1:2826 OLD LEE HWY
Practice Address - Street 2:SUITE # 110
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:703-560-8444
Practice Address - Fax:703-560-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2972-0001OtherCAREFIRST BC
VA005848784Medicaid
VA2972-0001OtherCAREFIRST BC
VA490671Medicare PIN