Healthcare Provider Details

I. General information

NPI: 1952628034
Provider Name (Legal Business Name): GALAM ASHEAQUE KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 02/28/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW DEPT OF PATHOLOGY
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3900 RESERVOIR RD NW # D335
WASHINGTON DC
20007-2126
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-3614
  • Fax:
Mailing address:
  • Phone: 202-687-3512
  • Fax: 202-687-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number0101253826
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberMD16138
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101253826
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: