Provider Demographics
NPI:1366536674
Name:KHATCHERESSIAN, JAMES LEON (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEON
Last Name:KHATCHERESSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7202 GLEN FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-0134
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:8007 DISCOVERY DR STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-8605
Practice Address - Country:US
Practice Address - Phone:804-287-3000
Practice Address - Fax:804-673-2731
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102680207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01120OtherMEDICARE GROUP PTAN
VA1366536674Medicaid
VAC05844OtherMEDICARE GROUP PTAN
VA4945957OtherCIGNA
VA352467OtherANTHEM BCBS
VAP00666337OtherRR MEDICARE PTAN
VAC05844OtherMEDICARE GROUP PTAN
VA017763V44Medicare PIN