Healthcare Provider Details

I. General information

NPI: 1013768563
Provider Name (Legal Business Name): FARHAN ANJUM KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST. BOX 800699
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-8485
  • Fax: 434-924-2231
Mailing address:
  • Phone: 434-924-8485
  • Fax: 434-924-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101289169
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: