Healthcare Provider Details

I. General information

NPI: 1154382018
Provider Name (Legal Business Name): GHAZALA Y KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 PLEASANT VALLEY RD SUITE 114
VIRGINIA BEACH VA
23464-8519
US

IV. Provider business mailing address

4221 PLEASANT VALLEY RD SUITE 114
VIRGINIA BEACH VA
23464-8519
US

V. Phone/Fax

Practice location:
  • Phone: 757-495-7420
  • Fax: 757-495-3917
Mailing address:
  • Phone: 757-495-7420
  • Fax: 757-495-3917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101042942
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: