Basic Information
| Provider Information | |||||||||
| NPI: | 1598993552 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHARSA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | AFUA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KPORTUFE | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | AFUA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7450 WILLOUGHBY LN | ||||||||
| Address2: | APT 202 | ||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201098511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035055497 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HOWARD UNIVERSITY HOSPITAL | ||||||||
| Address2: | 2041 GEORGIA AVENUE | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101252816 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MDC/RN/04806 | ZZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101252816 | VA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1598993552 | 05 | VA | MEDICAID |