Provider Demographics
NPI:1497311567
Name:KHALIL, MAHMOUD SHAKER (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:SHAKER
Last Name:KHALIL
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 1:200 WEST 57TH STREET
Mailing Address - Street 2:15TH AND 16TH FLOORS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2519
Mailing Address - Country:US
Mailing Address - Phone:212-247-8100
Mailing Address - Fax:
Practice Address - Street 1:200 WEST 57TH STREET
Practice Address - Street 2:15TH AND 16TH FLOORS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2519
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine