MEDICARE: DR. SALMA ZIA KHAN DO

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	207Q00000X	Family Medicine Physician	0116032628	VA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	0102207290	VA

General Provider Information

NPI Number	:	1366009458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALMA ZIA KHAN DO

Provider Business Mailing Address
First Line	:	414 PARK AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-4630
Country	:	US
Telephone Number	:	434-857-3600
Fax Number	:	434-857-3601

Provider Business Practice Location Address
First Line	:	414 PARK AVE
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24541-4630
Country	:	US
Telephone Number	:	434-857-3600
Fax Number	:	434-857-3601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	06/23/2022

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