Basic Information
| Provider Information | |||||||||
| NPI: | 1356383608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHEIR | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | MIKHAIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 GLENN DR | ||||||||
| Address2: | STE 10A | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034048189 | ||||||||
| FaxNumber: | 7034041131 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 GLENN DR | ||||||||
| Address2: | STE 10A | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034048189 | ||||||||
| FaxNumber: | 7034041131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | 0101039312 | VA | X | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ZP0101X | 0101039312 | VA | X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 6601839 | 05 | VA | MEDICAID |