Healthcare Provider Details

I. General information

NPI: 1922108521
Provider Name (Legal Business Name): SMEENA KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE SUITE 311
LANSDOWNE VA
20176-8100
US

IV. Provider business mailing address

11801 FOREST HEIGHTS CT
HERNDON VA
20170-2408
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9751
  • Fax: 703-723-9752
Mailing address:
  • Phone: 703-723-9751
  • Fax: 703-723-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101235906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: