Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0101242445 | VA |
Y | 207N00000X | Dermatologist | 237528 | NY |
N | 207N00000X | Dermatologist | 27320 | WV |
N | 207ND0101X | MOHS-Micrographic Surgeon | 0101242445 | VA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 237528 | NY |
N | 207ND0101X | MOHS-Micrographic Surgeon | 27320 | WV |
N | 207ND0900X | Dermatopathologist | 0101242445 | VA |
N | 207ND0900X | Dermatopathologist | 237528 | NY |
N | 207ND0900X | Dermatopathologist | 27320 | WV |
N | 207NS0135X | Procedural Dermatology | 0101242445 | VA |
N | 207NS0135X | Procedural Dermatology | 237528 | NY |
N | 207NS0135X | Procedural Dermatology | 27320 | WV |
NPI | 1326154253 |
---|---|
Provider Name | Dr. Amor Khachemoune |
First Address | Mc Lean, VA 22101-2913 |
Second Address | Mc Lean, VA 22101-2913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 01/05/2017 |