Provider Demographics
NPI:1073595997
Name:KHATRI, ABDUL MAJEED (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:MAJEED
Last Name:KHATRI
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 1:1209 NORTH MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4068
Mailing Address - Country:US
Mailing Address - Phone:936-560-1066
Mailing Address - Fax:936-560-9751
Practice Address - Street 1:1209 NORTH MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4068
Practice Address - Country:US
Practice Address - Phone:936-560-1066
Practice Address - Fax:936-560-9751
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0745174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00PN70OtherBLUE CROSS BLUE SHIELD
TX120163404Medicaid
TX00PN70OtherBLUE CROSS/BLUE SHIELD TX
TND66734Medicare UPIN
TX120163404Medicaid