Provider Demographics
NPI:1124244637
Name:EL-BADAWI, KHALED IQBAL (MD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:IQBAL
Last Name:EL-BADAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALED
Other - Middle Name:
Other - Last Name:IQBAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-247-7295
Mailing Address - Fax:856-291-8791
Practice Address - Street 1:401 YOUNG AVE STE FRNT
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3130
Practice Address - Country:US
Practice Address - Phone:856-247-7295
Practice Address - Fax:856-291-8791
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093360208C00000X
NJ25MA08776100208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0241211Medicaid
NJ192483A7TMedicare PIN