Healthcare Provider Details

I. General information

NPI: 1427616622
Provider Name (Legal Business Name): HANNAH NOOR KHAN GOODWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH NOOR KHAN MD

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

410 S MAPLE AVE APT 220
FALLS CHURCH VA
22046-4247
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-6652
  • Fax:
Mailing address:
  • Phone: 240-449-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116032633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: