Provider Demographics
NPI:1124087812
Name:NEURO CARE OF VIRGINIA PC
Entity type:Organization
Organization Name:NEURO CARE OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUBASHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-452-4546
Mailing Address - Street 1:4720 PUDDLEDOCK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1237
Mailing Address - Country:US
Mailing Address - Phone:804-452-4546
Mailing Address - Fax:804-452-4549
Practice Address - Street 1:4720 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1237
Practice Address - Country:US
Practice Address - Phone:804-452-4546
Practice Address - Fax:804-452-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710154786OtherDR. BU NPI
C08332OtherMEDICARE GROUP NUMBER
VA1023087368OtherDR. KHAN NPI