Provider Demographics
NPI:1144221367
Name:KHALIQI, TAMIM J (MD)
Entity Type:Individual
Prefix:
First Name:TAMIM
Middle Name:J
Last Name:KHALIQI
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 1:10 SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-9503
Mailing Address - Country:US
Mailing Address - Phone:315-724-3456
Mailing Address - Fax:
Practice Address - Street 1:GUTHRIE CORTLAND MEDICAL CENTER
Practice Address - Street 2:134 HOMER AVE
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1206
Practice Address - Country:US
Practice Address - Phone:315-939-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10006207LP2900X
NY257121207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0047005Medicaid
MT000082364Medicare ID - Type Unspecified
MT0047005Medicaid