Provider Demographics
NPI:1326154253
Name:KHACHEMOUNE, AMOR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOR
Middle Name:
Last Name:KHACHEMOUNE
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 1:1117 BRENTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2913
Mailing Address - Country:US
Mailing Address - Phone:703-748-6965
Mailing Address - Fax:
Practice Address - Street 1:1117 BRENTFIELD DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-2913
Practice Address - Country:US
Practice Address - Phone:703-748-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237528207N00000X, 207ND0101X, 207NS0135X, 207ND0900X
VA0101242445207N00000X, 207ND0101X, 207NS0135X, 207ND0900X
WV27320207N00000X, 207ND0900X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV7478AMedicare PIN