Provider Demographics
NPI:1336308139
Name:PEAY, KHENDRA IMAN (MD)
Entity Type:Individual
Prefix:
First Name:KHENDRA
Middle Name:IMAN
Last Name:PEAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 WISCONSIN AVE
Mailing Address - Street 2:SUITE 229
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3530
Mailing Address - Country:US
Mailing Address - Phone:301-648-7101
Mailing Address - Fax:240-235-4321
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:SUITE 229
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3530
Practice Address - Country:US
Practice Address - Phone:301-648-7101
Practice Address - Fax:240-235-4321
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD694382084P0800X
VA01012530862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336308139Medicaid
VA1336308139Medicaid