Basic Information
Provider Information | |||||||||
NPI: | 1891995510 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ATHAR | ||||||||
FirstName: | KHALID | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1912 SEPTEMBER CT | ||||||||
Address2: |   | ||||||||
City: | CULPEPER | ||||||||
State: | VA | ||||||||
PostalCode: | 227013313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2024600988 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 541 SUNSET LN STE 201 | ||||||||
Address2: |   | ||||||||
City: | CULPEPER | ||||||||
State: | VA | ||||||||
PostalCode: | 227013979 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5408290700 | ||||||||
FaxNumber: | 5408298191 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2007 | ||||||||
LastUpdateDate: | 04/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 0101243070 | VA | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 0101243070 | VA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 0101243070 | 01 | VA | VIRGINIA LICENSE | OTHER | 1891995510 | 05 | VA |   | MEDICAID |