Healthcare Provider Details

I. General information

NPI: 1831621440
Provider Name (Legal Business Name): MOHIB KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19441 GOLF VISTA PLZ STE 320
LANSDOWNE VA
20176-8272
US

IV. Provider business mailing address

19441 GOLF VISTA PLZ STE 320
LANSDOWNE VA
20176-8272
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-9800
  • Fax:
Mailing address:
  • Phone: 705-858-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD473121
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101274597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: