Healthcare Provider Details

I. General information

NPI: 1790162485
Provider Name (Legal Business Name): HAMPTON ADDIS KHANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 03/29/2021
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD
SPRINGFIELD VA
22152-1850
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5000
  • Fax:
Mailing address:
  • Phone: 703-454-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberMD047248
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: