Provider Demographics
NPI:1538266994
Name:KHAN PEDIATRIC CARE P.C.
Entity type:Organization
Organization Name:KHAN PEDIATRIC CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD;FAAP
Authorized Official - Phone:703-727-6664
Mailing Address - Street 1:1251 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2430
Mailing Address - Country:US
Mailing Address - Phone:703-444-3876
Mailing Address - Fax:
Practice Address - Street 1:44121 HARRY BYRD HWY.
Practice Address - Street 2:SUITE 215
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-727-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049571208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010158371Medicaid
VAG16515Medicare UPIN