Healthcare Provider Details

I. General information

NPI: 1134514227
Provider Name (Legal Business Name): DR. ALI TARIQ KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N GEORGE MASON DR STE 410
ARLINGTON VA
22205-3666
US

IV. Provider business mailing address

40 MITCHELL AVENUE
BINGHAMTON NY
13903
US

V. Phone/Fax

Practice location:
  • Phone: 703-524-4792
  • Fax:
Mailing address:
  • Phone: 607-772-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number295395
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101278813
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: