Healthcare Provider Details

I. General information

NPI: 1831185586
Provider Name (Legal Business Name): MONSURUL H KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 CENTREVILLE RD
CHANTILLY VA
20151-3224
US

IV. Provider business mailing address

556 GARRISONVILLE RD SUITE 204
STAFFORD VA
22554-7826
US

V. Phone/Fax

Practice location:
  • Phone: 703-657-6925
  • Fax:
Mailing address:
  • Phone: 540-720-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101236230
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101236230
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: