Provider Demographics
NPI:1386625564
Name:SOHERWARDY, KHALID N (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:N
Last Name:SOHERWARDY
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 1:317 N LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2353
Mailing Address - Country:US
Mailing Address - Phone:864-489-2588
Mailing Address - Fax:864-489-2589
Practice Address - Street 1:317 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2353
Practice Address - Country:US
Practice Address - Phone:864-489-2588
Practice Address - Fax:864-489-2589
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC191562Medicaid
SCG219110281Medicare PIN
SCG21911Medicare UPIN