Basic Information
Provider Information
NPI: 1003017682
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKHTAR
FirstName: NAUMAN
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224D CORNWALL ST NW STE 403
Address2:  
City: LEESBURG
State: VA
PostalCode: 201762704
CountryCode: US
TelephoneNumber: 7037376001
FaxNumber: 7034438643
Practice Location
Address1: 224D CORNWALL ST NW STE 204
Address2:  
City: LEESBURG
State: VA
PostalCode: 201762700
CountryCode: US
TelephoneNumber: 7037773262
FaxNumber: 7037773365
Other Information
ProviderEnumerationDate: 05/30/2007
LastUpdateDate: 04/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XS0114X0101247280VAY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery

ID Information
IDTypeStateIssuerDescription
100301768205VA MEDICAID


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