Provider Demographics
NPI:1477533859
Name:AMR, KHALED L (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:L
Last Name:AMR
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 1:6096 E MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4302
Mailing Address - Country:US
Mailing Address - Phone:614-751-1500
Mailing Address - Fax:614-751-1501
Practice Address - Street 1:6096 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4302
Practice Address - Country:US
Practice Address - Phone:614-715-1500
Practice Address - Fax:614-751-1501
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087312207L00000X, 207LP2900X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2628400Medicaid
OH2628400Medicaid
OHAM4183061Medicare PIN