Provider Demographics
NPI:1316961949
Name:ABDEL AZIZ, KHALED M (MD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:M
Last Name:ABDEL AZIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-6200
Mailing Address - Fax:412-359-6617
Practice Address - Street 1:320 E NORTH AVE STE 208
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-6200
Practice Address - Fax:412-359-6617
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429593207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101714647Medicaid
PA101714647Medicaid
OH2679445Medicaid
WV3810007475Medicaid