Provider Demographics
NPI:1558388199
Name:KHAN, KHALID (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
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 1:11901 HOGANS ALY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8608
Mailing Address - Country:US
Mailing Address - Phone:804-530-3770
Mailing Address - Fax:804-530-3770
Practice Address - Street 1:200 MEDICAL PARK BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9274
Practice Address - Country:US
Practice Address - Phone:804-765-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230069207P00000X
WI37406207P00000X
LA12159R207P00000X
IL36093838207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005884942Medicaid
G50504Medicare UPIN
VA005884942Medicaid