Provider Demographics
NPI:1982262382
Name:KHADER, ALI RAFIQ (MD)
Entity type:Individual
Prefix:MR
First Name:ALI
Middle Name:RAFIQ
Last Name:KHADER
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 1:32 2ND AVE APT 117
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4435
Mailing Address - Country:US
Mailing Address - Phone:929-289-0959
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST RM S2A19
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3477
Practice Address - Fax:410-328-0641
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2025-05-09
Deactivation Date:2020-01-17
Deactivation Code:
Reactivation Date:2020-04-29
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA283247390200000X
MDD01017272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program