Basic Information
| Provider Information | |||||||||
| NPI: | 1821366923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARRHYTHMIA SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 AMHERST ST. | ||||||||
| Address2: | 1-C | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405362579 | ||||||||
| FaxNumber: | 5405367235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 AMHERST ST. | ||||||||
| Address2: | 1-C | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405362579 | ||||||||
| FaxNumber: | 5405367235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2011 | ||||||||
| LastUpdateDate: | 06/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | EJAZ | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5405362579 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1821366923 | 05 | VA | MEDICAID | DS3898 | 01 | VA | MEDICARE RR | OTHER | 3810022265 | 05 | WV | MEDICAID |