MEDICARE: ABDUR R KHAN 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	207Q00000X	Family Medicine Physician	0101042941	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1992766851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDUR R KHAN MD

Provider Business Mailing Address
First Line	:	4221 PLEASANT VALLEY ROAD
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 ROAD
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	02/13/2008

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