Provider Demographics
NPI:1174565899
Name:KHALID, OMER (MD)
Entity type:Individual
Prefix:
First Name:OMER
Middle Name:
Last Name:KHALID
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 1:2369 STAPLES MILL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2918
Mailing Address - Country:US
Mailing Address - Phone:804-285-8206
Mailing Address - Fax:804-497-5469
Practice Address - Street 1:201 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-285-8206
Practice Address - Fax:804-497-5469
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260793207RG0100X
IN01064604A207R00000X
NC2014-00820207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174565899Medicaid
IN000000556532OtherANTHEM
IN200902480Medicaid
NC1174565899Medicaid
VA1174565899Medicaid
IN715530CEEEMedicare PIN
VAVVN488AMedicare PIN