Healthcare Provider Details

I. General information

NPI: 1023451341
Provider Name (Legal Business Name): AKHIL KHETARPAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX 800719
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

10401 SPOTSYLVANIA AVE STE 200
FREDERICKSBRG VA
22408-8606
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2150
  • Fax:
Mailing address:
  • Phone: 540-361-1000
  • Fax: 540-361-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101266699
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101266699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: