Provider Demographics
NPI:1952379737
Name:SHUMBURO, KHALID MAHDI (MD)
Entity Type:Individual
Prefix:MR
First Name:KHALID
Middle Name:MAHDI
Last Name:SHUMBURO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:#135
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0488
Mailing Address - Fax:703-961-0480
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:#135
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-961-0488
Practice Address - Fax:703-961-0480
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101233836207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010298016Medicaid
VA010298016Medicaid
DC019478N18Medicare PIN
VA009919N55Medicare PIN