Provider Demographics
NPI:1588210124
Name:KHALIL, MAHMOUD I
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:I
Last Name:KHALIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N BROADWAY STE 510
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1084
Mailing Address - Country:US
Mailing Address - Phone:914-302-0100
Mailing Address - Fax:914-302-0060
Practice Address - Street 1:755 N BROADWAY STE 510
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1084
Practice Address - Country:US
Practice Address - Phone:914-302-0100
Practice Address - Fax:914-302-0060
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12037208800000X
NY309598208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology