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General NPI Number Information
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NPI Number | 1215038112
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Entity Type | Individual
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Provider Name | SANDEEP JITENDRA KHANDHAR MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 8613 ROUTE 29 # 200N
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City | FAIRFAX
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State | VA
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Zip | 22031-2171
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Country | US
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Telephone | 571-350-8400
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Fax | 703-940-8748
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Provider Business Mailing Address
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Address Line | 3040 WILLIAMS DR STE 100
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 571-350-8400
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Fax | 703-280-5390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101242034
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101242034
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 2006-01403
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 0101242034
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License Number State | VA
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