Provider Demographics
NPI:1851357222
Name:KHAN, NADEEM ANWAR (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:ANWAR
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 1:12230 BRANDERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1626
Mailing Address - Country:US
Mailing Address - Phone:804-939-7065
Mailing Address - Fax:804-715-4714
Practice Address - Street 1:12230 BRANDERS CREEK DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1626
Practice Address - Country:US
Practice Address - Phone:804-939-7065
Practice Address - Fax:804-715-4714
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235833208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA205308OtherBCBS
VA1851357222Medicaid
VA0101235833OtherMEDICAL LICENSE
VAP00252947Medicare PIN
VA205308OtherBCBS
VAI61202Medicare UPIN
VA0603180002Medicare NSC
VA1851357222Medicaid