MEDICARE: DR. HEMET KHERBACHE M.D.

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	207UN0902X	Nuclear Imaging & Therapy Physician	0101281744	VA

General Provider Information

NPI Number	:	1578731808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEMET KHERBACHE M.D.

Provider Business Mailing Address
First Line	:	3289 WOODBURN RD STE 60
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-7337
Country	:	US
Telephone Number	:	703-698-0666
Fax Number	:	703-698-5935

Provider Business Practice Location Address
First Line	:	3289 WOODBURN RD STE 60
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-7337
Country	:	US
Telephone Number	:	703-698-0666
Fax Number	:	703-698-5935

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	06/13/2024

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