Provider Demographics
NPI:1235257577
Name:DAWOOD, KHYTAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:KHYTAM
Middle Name:
Last Name:DAWOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 CATO AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2754
Mailing Address - Country:US
Mailing Address - Phone:814-231-8820
Mailing Address - Fax:814-231-8857
Practice Address - Street 1:1993 CATO AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2754
Practice Address - Country:US
Practice Address - Phone:814-231-8820
Practice Address - Fax:814-231-8857
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK16825Medicare ID - Type Unspecified
ILQ41765Medicare UPIN