Provider Demographics
NPI:1073503058
Name:KHALID, MOHAMMAD ATIF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ATIF
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 1:64 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1719
Mailing Address - Country:US
Mailing Address - Phone:585-410-6266
Mailing Address - Fax:
Practice Address - Street 1:64 SHADY LN
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1719
Practice Address - Country:US
Practice Address - Phone:585-410-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2331082085R0202X
CAA997972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02564818Medicaid
NY02564818Medicaid
RA1927Medicare PIN