Provider Demographics
NPI:1194711846
Name:AL-TALIB, KHALID KHALIL (MD)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:KHALIL
Last Name:AL-TALIB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6830 HOSPITAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4373
Mailing Address - Country:US
Mailing Address - Phone:443-559-5063
Mailing Address - Fax:443-559-5078
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:443-559-5063
Practice Address - Fax:443-559-5078
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD38882207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD064251700Medicaid
MD370L899BMedicare ID - Type Unspecified
MDE48629Medicare UPIN