Provider Demographics
NPI:1366892127
Name:KHAIRA, NEELAM (MD)
Entity type:Individual
Prefix:
First Name:NEELAM
Middle Name:
Last Name:KHAIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 BIRDS FORT TRAIL
Mailing Address - Street 2:VIRIDIAN MD
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-1203
Mailing Address - Country:US
Mailing Address - Phone:682-427-7208
Mailing Address - Fax:480-781-4946
Practice Address - Street 1:1606 BIRDS FORT TRAIL
Practice Address - Street 2:VIRIDIAN MD
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1203
Practice Address - Country:US
Practice Address - Phone:682-427-7208
Practice Address - Fax:480-781-4946
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142035208000000X
TXV4688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105545800Medicaid