Provider Demographics
NPI:1205087798
Name:KHAWAJA-JAVAID, QURRATULAEN (PA)
Entity type:Individual
Prefix:
First Name:QURRATULAEN
Middle Name:
Last Name:KHAWAJA-JAVAID
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:QURRATULAEN
Other - Middle Name:
Other - Last Name:KHAWAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3300 GALLOWS RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3300
Mailing Address - Country:US
Mailing Address - Phone:703-776-4001
Mailing Address - Fax:703-776-3623
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3300
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-3623
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012786363AM0700X
TXPA08685363AS0400X
VA0110006520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EH924OtherBCBS
TX350362YKY3Medicare PIN