Provider Demographics
NPI:1699749333
Name:EL-KHOURY, SEMAAN Y (MD)
Entity type:Individual
Prefix:DR
First Name:SEMAAN
Middle Name:Y
Last Name:EL-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 309
Mailing Address - Street 2:
Mailing Address - City:AULANDER
Mailing Address - State:NC
Mailing Address - Zip Code:27805-0309
Mailing Address - Country:US
Mailing Address - Phone:252-345-3791
Mailing Address - Fax:252-345-0480
Practice Address - Street 1:114 HOLLOWELL ROAD
Practice Address - Street 2:
Practice Address - City:AULANDER
Practice Address - State:NC
Practice Address - Zip Code:27805-0309
Practice Address - Country:US
Practice Address - Phone:252-345-3791
Practice Address - Fax:252-345-0480
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601299173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900414Medicaid
NC8930348OtherMEDICAID
NC30348OtherBCBS
NC186288OtherMEDCOST
NC2231855EMedicare PIN
NCG35559Medicare UPIN
NC30348OtherBCBS
NC2345347Medicare ID - Type Unspecified