Healthcare Provider Details

I. General information

NPI: 1528852308
Provider Name (Legal Business Name): CORE PATH MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 LEESBURG PIKE STE 213
ALEXANDRIA VA
22302-1101
US

IV. Provider business mailing address

4900 LEESBURG PIKE STE 213
ALEXANDRIA VA
22302-1101
US

V. Phone/Fax

Practice location:
  • Phone: 703-705-9285
  • Fax: 703-705-9285
Mailing address:
  • Phone: 703-705-9285
  • Fax: 703-705-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHABANA KHAN
Title or Position: PRESIDENT
Credential:
Phone: 703-705-9285