Provider Demographics
NPI:1063679827
Name:MOUGHRABIEH, MOHAMAD KHALED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:KHALED
Last Name:MOUGHRABIEH
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 1:943 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-7734
Mailing Address - Country:US
Mailing Address - Phone:901-358-0326
Mailing Address - Fax:901-358-9010
Practice Address - Street 1:943 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-7734
Practice Address - Country:US
Practice Address - Phone:901-358-0326
Practice Address - Fax:901-358-9010
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-050529207R00000X
TN44474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1063679827Medicaid