Provider Demographics
NPI:1174546527
Name:KHALIL, FAUZI RAIF (MD)
Entity type:Individual
Prefix:DR
First Name:FAUZI
Middle Name:RAIF
Last Name:KHALIL
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 1:1325 MOUNT HERMON RD
Mailing Address - Street 2:STE 9A
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-749-6833
Mailing Address - Fax:410-749-5139
Practice Address - Street 1:1325 MOUNT HERMON RD
Practice Address - Street 2:STE 9A
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-749-6833
Practice Address - Fax:410-749-5139
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD547141900Medicaid
MD82634OtherMDIPA OPT
MD4682FOtherBCBS
MD4682FOtherBCBS
MD4682Medicare ID - Type Unspecified