Provider Demographics
NPI:1467795476
Name:KHALID, SAMRA (DO)
Entity Type:Individual
Prefix:
First Name:SAMRA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 BLOOMFIELD AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2444
Mailing Address - Country:US
Mailing Address - Phone:941-465-7073
Mailing Address - Fax:
Practice Address - Street 1:900 LANIDEX PLZ STE 220
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2707
Practice Address - Country:US
Practice Address - Phone:973-831-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09964800207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program