MEDICARE: PLEASANT VALLEY MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician		VA
2	207Q00000X	Family Medicine Physician		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330829	OTHER	VA	BCBS
2	330828	OTHER	VA	BCBS

General Provider Information

NPI Number	:	1295826071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT VALLEY MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	4221 PLEASANT VALLEY RD
Second Line	:	SUITE 114
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8519
Country	:	US
Telephone Number	:	757-495-7420
Fax Number	:	757-495-3917

Provider Business Practice Location Address
First Line	:	4221 PLEASANT VALLEY RD
Second Line	:	SUITE 114
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8519
Country	:	US
Telephone Number	:	757-495-7420
Fax Number	:	757-495-3917

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDUR R KHAN
Credential	:	M.D.
Telephone Number	:	757-495-7420

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/13/2008

Similar Medicare Providers

1992766851 — ABDUR R KHAN MD
Practice Location Address:

4221 PLEASANT VALLEY ROAD , SUITE 114
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23464-8519

Practice Phone: 757-495-7420
Practice Fax: 757-495-3917

1154382018 — GHAZALA Y KHAN MD
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VIRGINIA BEACH, VA
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1487543229 — SHARITA MILLER
Practice Location Address:

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23464-8519

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1215231691 — MR. PETER M DAVID
Practice Location Address:

1465 HEWITT DR
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1932613718 — SCOTT LENON IDC
Practice Location Address:

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1457815037 — MRS. JENNIFER FRANKL
Practice Location Address:

8519 PORTOBELLO LN
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