MEDICARE: DR. KATAYOUN KHOSRAVANI MD

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	2083P0901X	Public Health & General Preventive Medicine Physician	0101249055	VA
2	207Q00000X	Family Medicine Physician	0101249055	VA
3	207R00000X	Internal Medicine Physician	D0080958	MD

General Provider Information

NPI Number	:	1659623221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATAYOUN KHOSRAVANI MD

Provider Business Mailing Address
First Line	:	20501 SENECA MEADOWS PKWY STE 200
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-7018
Country	:	US
Telephone Number	:	227-250-0255
Fax Number	:	240-238-6536

Provider Business Practice Location Address
First Line	:	7447 CENTRAL BUSINESS PARK DR
Second Line	:	SUITE 104
City	:	NORFOLK
State	:	VA
Zip	:	23513-2831
Country	:	US
Telephone Number	:	757-853-1380
Fax Number	:	855-252-4450

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	04/06/2026

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