Provider Demographics
NPI:1407802671
Name:KHOSRAVI, HAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMED
Middle Name:
Last Name:KHOSRAVI
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 1:2079 DANIEL STUART SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3317
Mailing Address - Country:US
Mailing Address - Phone:703-491-5600
Mailing Address - Fax:703-491-1744
Practice Address - Street 1:2079 DANIEL STUART SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3317
Practice Address - Country:US
Practice Address - Phone:703-491-5600
Practice Address - Fax:703-491-1744
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236341207RH0003X
MDD0061363207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010104173Medicaid
VA002138517006OtherUHC
11350001OtherCAREFIRST BCBS
VA220441OtherAMERIGROUP
3818139OtherAETNA HMO
VA5409063OtherCIGNA
VA7373248OtherAETNA NON HMO
VA298274OtherANTHEM BCBS
VA002138517006OtherUHC
VA010104173Medicaid