Provider Demographics
NPI:1528046026
Name:KHAN, SALMAN (MD)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:
Last Name:KHAN
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 1:4013 WATER OVERLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-5007
Mailing Address - Country:US
Mailing Address - Phone:804-243-3282
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-287-7270
Practice Address - Fax:804-285-0726
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058157208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA176037OtherBCBS
VA010143934Medicaid
VAC06778OtherGROUP PTAN
VA00434P03Medicare PIN
VA176037OtherBCBS
VAC06778OtherGROUP PTAN