Provider Demographics
NPI:1003850314
Name:SAWAGED, KHALID S (DO)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:S
Last Name:SAWAGED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 MT PROSPECT AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3109
Mailing Address - Country:US
Mailing Address - Phone:973-497-9611
Mailing Address - Fax:973-497-9621
Practice Address - Street 1:671 MT PROSPECT AVE
Practice Address - Street 2:STE 1
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3109
Practice Address - Country:US
Practice Address - Phone:973-497-9611
Practice Address - Fax:973-497-9621
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06352900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7562501Medicaid
NJ009111Medicare PIN
G67471Medicare UPIN