Provider Demographics
NPI:1427025360
Name:KHOURY, JACQUES (MD)
Entity type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:KHOURY
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:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-0350
Mailing Address - Country:US
Mailing Address - Phone:215-723-2333
Mailing Address - Fax:215-723-9112
Practice Address - Street 1:2050 W CHESTER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2742
Practice Address - Country:US
Practice Address - Phone:610-449-1525
Practice Address - Fax:610-853-3687
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035174L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00181700OtherRAILROAD MEDICARE
PA007311400003Medicaid
PAP00181700OtherRAILROAD MEDICARE
PAC32037Medicare UPIN