Provider Demographics
NPI:1285825604
Name:ABDELAZEEZ KHALED, MOHAMAD A (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:A
Last Name:ABDELAZEEZ KHALED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMAD
Other - Middle Name:ABDELAZEEEZ
Other - Last Name:KHALED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MSURG
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-9033
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 503
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1619
Practice Address - Country:US
Practice Address - Phone:413-794-5600
Practice Address - Fax:413-794-5242
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262884207T00000X
CT54621207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery