Basic Information
| Provider Information | |||||||||
| NPI: | 1215259775 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEIGHBORHOOD HEALTH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEIGHBORHOOD HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2518 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035655568 | ||||||||
| FaxNumber: | 7032243629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N HOWARD ST. | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035655568 | ||||||||
| FaxNumber: | 7035351583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2010 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | BASIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM ED | ||||||||
| AuthorizedOfficialTelephone: | 7035355568 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.