Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0101230654 | VA |
NPI | 1023087368 |
---|---|
Provider Name | Mubashir A Khan |
First Address | Prince George, VA 23875-1237 |
Second Address | Prince George, VA 23875-1237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 26/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007104545 | (05) | VA |
C08332 | MEDICARE GROUP NUMBER (01) | |
H04705 | (02) |