Provider Demographics
NPI:1609879303
Name:KHAN, FAREEHA I (MD)
Entity Type:Individual
Prefix:DR
First Name:FAREEHA
Middle Name:I
Last Name:KHAN
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 1:1900 GALLOWS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3886
Mailing Address - Country:US
Mailing Address - Phone:703-560-1075
Mailing Address - Fax:703-560-1076
Practice Address - Street 1:1900 GALLOWS RD STE 100
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3886
Practice Address - Country:US
Practice Address - Phone:703-560-1075
Practice Address - Fax:703-560-1076
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2021-11-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-06-23
Provider Licenses
StateLicense IDTaxonomies
VA0101055045174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7489487OtherAETNA PPO
VAP00094786OtherRR MEDICARE
VA267155OtherANTHEM
VA010034736Medicaid
VA2128312OtherMAMSI
VA3304254OtherAETNA HMO
VAJ093 0001OtherCAREFIRST BCBS
VA3304254OtherAETNA HMO
VA2128312OtherMAMSI