Provider Demographics
NPI:1871045773
Name:KHAN, ANNUM (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNUM
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD EXECUTIVE PLAZA 1
Mailing Address - Street 2:STE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:703-738-4331
Mailing Address - Fax:703-642-1876
Practice Address - Street 1:1750 TYSONS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4227
Practice Address - Country:US
Practice Address - Phone:703-914-8000
Practice Address - Fax:703-642-1876
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical