Healthcare Provider Details

I. General information

NPI: 1760477145
Provider Name (Legal Business Name): VIKRAM KHOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8680 HOSPITAL WAY
MANASSAS VA
20110-4287
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 703-369-8055
  • Fax: 703-369-8565
Mailing address:
  • Phone: 703-369-8055
  • Fax: 703-369-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101043263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: