Provider Demographics
NPI:1699338780
Name:KHALID, KHURRAM REHAN (DO)
Entity type:Individual
Prefix:
First Name:KHURRAM
Middle Name:REHAN
Last Name:KHALID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S GROVE ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6309
Mailing Address - Country:US
Mailing Address - Phone:347-393-4007
Mailing Address - Fax:
Practice Address - Street 1:300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2161
Practice Address - Country:US
Practice Address - Phone:516-562-4520
Practice Address - Fax:516-825-4753
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY319269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program