Healthcare Provider Details

I. General information

NPI: 1336111301
Provider Name (Legal Business Name): USMAN A KHAWAJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/07/2023
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OLD LEXINGTON RD
THOMASVILLE NC
27360-3428
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-472-1191
  • Fax: 336-172-1208
Mailing address:
  • Phone: 336-472-1191
  • Fax: 336-472-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200101078
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number200101078
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: