Provider Demographics
NPI:1225076375
Name:GORGUI, KHALIL F (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:F
Last Name:GORGUI
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 1:8 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-1115
Mailing Address - Country:US
Mailing Address - Phone:302-846-0618
Mailing Address - Fax:302-846-3668
Practice Address - Street 1:8 E GROVE ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-1115
Practice Address - Country:US
Practice Address - Phone:302-846-0618
Practice Address - Fax:302-846-3668
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000631201Medicaid
DE0000631201Medicaid
G01389T01Medicare ID - Type Unspecified