Provider Demographics
NPI:1508872698
Name:KHALILI, BEHROOZ (MD)
Entity Type:Individual
Prefix:
First Name:BEHROOZ
Middle Name:
Last Name:KHALILI
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 1:180 FORT COUCH RD STE 425
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1051
Mailing Address - Country:US
Mailing Address - Phone:412-283-1133
Mailing Address - Fax:412-283-1139
Practice Address - Street 1:180 FORT COUCH RD STE 425
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1051
Practice Address - Country:US
Practice Address - Phone:412-283-1133
Practice Address - Fax:412-283-1139
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037839L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000728799Medicaid
PA000728799Medicaid
PAB40061Medicare UPIN