Provider Demographics
NPI:1366641714
Name:VAID, KHATIJA MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:KHATIJA
Middle Name:MOHAMMAD
Last Name:VAID
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 1:4960 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2268
Mailing Address - Country:US
Mailing Address - Phone:815-387-5309
Mailing Address - Fax:815-387-5316
Practice Address - Street 1:4960 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2268
Practice Address - Country:US
Practice Address - Phone:815-387-5309
Practice Address - Fax:815-387-5316
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361270212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry