Provider Demographics
NPI:1720622764
Name:KHAN, MOHAMMAD ADEEM (PA-C)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD ADEEM
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
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 1:52 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3850
Mailing Address - Country:US
Mailing Address - Phone:518-258-7210
Mailing Address - Fax:
Practice Address - Street 1:300 FORT EVANS RD NE STE 103
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4491
Practice Address - Country:US
Practice Address - Phone:571-252-9953
Practice Address - Fax:571-252-9954
Is Sole Proprietor?:No
Enumeration Date:2019-11-02
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028236207P00000X
390200000X
VA0110009696363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program