Healthcare Provider Details

I. General information

NPI: 1891364659
Provider Name (Legal Business Name): NIGHAT ZAHOOR KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 PORTER ST
FORT DETRICK MD
21702-9234
US

IV. Provider business mailing address

1546 PORTER ST
FORT DETRICK MD
21702-9234
US

V. Phone/Fax

Practice location:
  • Phone: 757-576-6786
  • Fax:
Mailing address:
  • Phone: 301-619-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number0101276122
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101276122
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: