Provider Demographics
NPI:1821012360
Name:KHAN, NAEEM (MD)
Entity Type:Individual
Prefix:
First Name:NAEEM
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 1:6239 WILLOWFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1037
Mailing Address - Country:US
Mailing Address - Phone:703-403-1541
Mailing Address - Fax:
Practice Address - Street 1:17017 DUMFRIES RD
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1927
Practice Address - Country:US
Practice Address - Phone:571-285-4677
Practice Address - Fax:571-285-4946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10357594Medicaid
00X286H 01Medicare ID - Type Unspecified
I55300Medicare UPIN