Healthcare Provider Details

I. General information

NPI: 1740641091
Provider Name (Legal Business Name): NEIGHBORHOOD HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WASHINGTON BLVD
ARLINGTON VA
22204-5703
US

IV. Provider business mailing address

PO BOX 4320
GLEN ALLEN VA
23058-4320
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-5568
  • Fax: 703-299-1794
Mailing address:
  • Phone: 804-237-7690
  • Fax: 804-237-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. BASIM KHAN
Title or Position: CEO
Credential: MD
Phone: 703-535-5568