=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952474116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALFRED N. KHOURY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 HAMAKER CT SUITE 501
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-698-5350
-----------------------------------------------------
Fax | 703-204-1074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6530 SOTHORON RD
-----------------------------------------------------
City | MCLEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-3022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-288-0995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 0101040608
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------