Provider Demographics
NPI:1205862190
Name:KHAIRGHADAM, HAMID R (CRNA)
Entity Type:Individual
Prefix:MR
First Name:HAMID
Middle Name:R
Last Name:KHAIRGHADAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 PHILLIPS MILL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2119
Mailing Address - Country:US
Mailing Address - Phone:410-420-7630
Mailing Address - Fax:
Practice Address - Street 1:500 UPPERCHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BELAIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-420-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137569367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD435101100Medicaid
MDC082Medicare ID - Type Unspecified
MD435101100Medicaid