Healthcare Provider Details

I. General information

NPI: 1023501780
Provider Name (Legal Business Name): AHMED KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 LAKE MANASSAS DR
GAINESVILLE VA
20155-3257
US

IV. Provider business mailing address

PO BOX 748613
ATLANTA GA
30374-8613
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-4045
  • Fax: 703-753-8037
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD483711
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101286164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: