Provider Demographics
NPI:1508823717
Name:SOROUR, KHALED A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:A
Last Name:SOROUR
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 1:15 MILLERS BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:ANESTHETICS OF BROCKTON, PC
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7656
Practice Address - Fax:508-941-6345
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10810207L00000X, 207LC0200X
MA208679207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110037805AMedicaid
202010504OtherCHOICECARE
MA2063450Medicaid
458318OtherTUFTS
97356201OtherNETWORK
P0066427OtherRAILROAD
408547OtherBLUE CHIP
4268OtherNHP
57718OtherFHP
AA31806OtherHPHC
0028221OtherNHP
2326993OtherCIGNA
202010504OtherGREAT WEST
3817294OtherAETNA
458348OtherTUFTS
202010504OtherFIRST HEALTH
202010504OtherSR WHOLE HEALTH
276072OtherHPHC
AA64130OtherHPHC
MAJ25636OtherBCBS
0028221OtherNHP
4268OtherNHP
MAJ25636OtherBCBS
P0066427OtherRAILROAD
3817294OtherAETNA
202010504OtherFIRST HEALTH
MAHX3958Medicare PIN
408547OtherBLUE CHIP
RI7009585Medicare PIN