Provider Demographics
NPI:1225015506
Name:KHOOBLALL, NECKLALL (MD)
Entity Type:Individual
Prefix:
First Name:NECKLALL
Middle Name:
Last Name:KHOOBLALL
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 1:253 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4082
Mailing Address - Country:US
Mailing Address - Phone:330-792-9630
Mailing Address - Fax:
Practice Address - Street 1:253 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4082
Practice Address - Country:US
Practice Address - Phone:330-792-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH61266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0896277Medicaid
OHF34767Medicare UPIN
OH0896277Medicaid