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General NPI Number Information
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NPI Number | 1720622764
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Entity Type | Individual
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Provider Name | MOHAMMAD ADEEM KHAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/02/2019
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 300 FORT EVANS RD NE STE 103
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City | LEESBURG
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State | VA
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Zip | 20176-4491
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Country | US
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Telephone | 571-252-9953
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Fax | 571-252-9954
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Provider Business Mailing Address
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Address Line | 52 SCHOOLHOUSE RD
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City | ALBANY
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State | NY
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Zip | 12203-3850
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Country | US
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Telephone | 518-258-7210
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 028236
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110009696
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License Number State | VA
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