Provider Demographics
NPI:1669449435
Name:KHAN, KANWAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:KANWAL
Middle Name:S
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3517 W OX RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1705
Mailing Address - Country:US
Mailing Address - Phone:814-938-3343
Mailing Address - Fax:814-938-3369
Practice Address - Street 1:14631 LEE HWY
Practice Address - Street 2:SUITE 405
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5824
Practice Address - Country:US
Practice Address - Phone:703-830-1950
Practice Address - Fax:703-830-2070
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI18766Medicare UPIN