Provider Demographics
NPI:1013136464
Name:KHAJAVI, MEHRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:
Last Name:KHAJAVI
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:P.O. BOX 4458
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20177
Mailing Address - Country:US
Mailing Address - Phone:703-895-2237
Mailing Address - Fax:
Practice Address - Street 1:1004 SUSHRUTA DR STE C
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8801
Practice Address - Country:US
Practice Address - Phone:304-264-0888
Practice Address - Fax:304-264-0878
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22758207QG0300X
VA0101241072207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00449865OtherRAILROAD MEDICARE
WVWV2358C487OtherMEDICARE PTAN