Healthcare Provider Details

I. General information

NPI: 1427119965
Provider Name (Legal Business Name): TARIQ KHURSHID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 WOODLEIGH LN
FAIRFAX VA
22032-4060
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 703-259-9930
  • Fax:
Mailing address:
  • Phone: 571-291-6131
  • Fax: 571-291-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101057606
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD53408
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: