Provider Demographics
NPI:1558522300
Name:DANN, KHALILAH C (MD)
Entity Type:Individual
Prefix:
First Name:KHALILAH
Middle Name:C
Last Name:DANN
Suffix:
Gender:F
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:PO BOX 32246
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 COYLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0301
Practice Address - Country:US
Practice Address - Phone:916-967-4030
Practice Address - Fax:916-967-4060
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC168238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014582OtherHIGHMARK BLUE SHIELD
PA102630935Medicaid
PA1007288440104Medicaid
PA102630935Medicaid