Provider Demographics
NPI:1689847287
Name:KHANDKER, SAMIUR RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:SAMIUR
Middle Name:RAHMAN
Last Name:KHANDKER
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 1:12025 NEW DOMINION PKWY APT 208
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-6265
Mailing Address - Country:US
Mailing Address - Phone:571-218-7477
Mailing Address - Fax:
Practice Address - Street 1:12025 NEW DOMINION PKWY APT 208
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-6265
Practice Address - Country:US
Practice Address - Phone:571-218-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251972207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine