Provider Demographics
NPI:1699871699
Name:KHAN, IMRAN A (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1707
Mailing Address - Country:US
Mailing Address - Phone:703-858-1800
Mailing Address - Fax:703-858-1801
Practice Address - Street 1:19465 DEERFIELD AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1707
Practice Address - Country:US
Practice Address - Phone:703-858-1800
Practice Address - Fax:703-858-1801
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242630207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA343279OtherANTHEM BCBS ID#
VA52-1839524OtherTAX ID#
VA5436636OtherCIGNA ID#
VA2174265OtherOPTIMUM CHOICE ID#
VA02459274OtherUNITED HEALTHCARE CARE ID#
VA7891580OtherAETNA ID#
VA1113-0006OtherCAP CARE ID#
VA0957850001Medicare NSC
VAE90545Medicare UPIN
VA200000581Medicare PIN
VA02459274OtherUNITED HEALTHCARE CARE ID#