Provider Demographics
NPI:1659309516
Name:KHAN, OMAR IQBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:IQBAL
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 1:10 CENTER DRIVE
Mailing Address - Street 2:10-CRC-65700
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:240-281-2317
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:NATIONAL INSTITUTES OF HEALTH,
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-443-8960
Practice Address - Fax:301-480-3528
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239393207Q00000X, 2084N0600X
NHRT-15982084N0400X
PAMD4424632084N0400X
VT042.00117422084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA220301Medicare PIN