Provider Demographics
NPI:1326019043
Name:KHALID, TANIA (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:AZIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7988 BAYSHORE CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8367
Mailing Address - Country:US
Mailing Address - Phone:812-962-0858
Mailing Address - Fax:
Practice Address - Street 1:600 MARY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747-0001
Practice Address - Country:US
Practice Address - Phone:812-450-7338
Practice Address - Fax:812-450-2193
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01011641A207R00000X
IN01061641A208M00000X
NV13339208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1326019043Medicaid
IN200815550Medicaid
KY64114895Medicaid
IN000000391348OtherBCBS - DEACONESS GATEWAY
IN000000391354OtherBCBS - DEACONESS MARY ST
INP00318221OtherRR MCARE
INP00318221OtherRR MCARE
I54533Medicare UPIN
KY64114895Medicaid
IL$$$$$$$$$Medicaid