Basic Information
Provider Information
NPI: 1801470778
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KHAN
FirstName: NAVEERA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MBBS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 IRVING ST. NW
Address2: DEPT. OF INTERNAL MEDICINE
City: WASHINGTON
State: DC
PostalCode: 20010
CountryCode: US
TelephoneNumber: 2028778278
FaxNumber: 2028776292
Practice Location
Address1: 110 IRIVING ST NW
Address2: DEPARTMENT OF INTERNAL MEDICINE
City: WASHINGTON DC
State: DC
PostalCode: 20010
CountryCode: US
TelephoneNumber: 2028778278
FaxNumber: 2028776292
Other Information
ProviderEnumerationDate: 05/07/2021
LastUpdateDate: 03/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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