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General NPI Number Information
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NPI Number | 1407802671
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Entity Type | Individual
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Provider Name | HAMED KHOSRAVI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 2079 DANIEL STUART SQ
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3317
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Country | US
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Telephone | 703-491-5600
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Fax | 703-491-1744
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Provider Business Mailing Address
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Address Line | 2079 DANIEL STUART SQ
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3317
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Country | US
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Telephone | 703-491-5600
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Fax | 703-491-1744
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 0101236341
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | D0061363
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License Number State | MD
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