Provider Demographics
NPI:1457686487
Name:KHEDR, ESSAM MOHAMED (DPM)
Entity Type:Individual
Prefix:DR
First Name:ESSAM
Middle Name:MOHAMED
Last Name:KHEDR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 MECHANIC STREET
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2133
Mailing Address - Country:US
Mailing Address - Phone:978-249-1295
Mailing Address - Fax:978-249-5669
Practice Address - Street 1:80 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2133
Practice Address - Country:US
Practice Address - Phone:978-249-1295
Practice Address - Fax:978-249-5669
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery