Provider Demographics
NPI:1437111804
Name:KHASRU, MUHAMMED A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMED
Middle Name:A
Last Name:KHASRU
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 1:3533 TURNBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4665
Mailing Address - Country:US
Mailing Address - Phone:910-864-7801
Mailing Address - Fax:
Practice Address - Street 1:518 BEAUMONT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4447
Practice Address - Country:US
Practice Address - Phone:910-487-5574
Practice Address - Fax:910-487-5542
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-007202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2297222BMedicare PIN