Provider Demographics
NPI:1306227400
Name:KHATIB, JOANNA ESAM TALIB (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:ESAM TALIB
Last Name:KHATIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29691 MARSH CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5560
Mailing Address - Country:US
Mailing Address - Phone:857-331-4251
Mailing Address - Fax:
Practice Address - Street 1:232 MITCHELL ST UNIT 102
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-9412
Practice Address - Country:US
Practice Address - Phone:302-648-7999
Practice Address - Fax:302-645-8837
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63615390200000X
DEC1-0013593207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program