Provider Demographics
NPI:1629047378
Name:MAQSOOD, KHALID (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:MAQSOOD
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:PO BOX 120930
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0930
Mailing Address - Country:US
Mailing Address - Phone:352-242-1665
Mailing Address - Fax:352-243-1649
Practice Address - Street 1:821 OAKLEY SEAVER DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:352-242-1665
Practice Address - Fax:352-243-1649
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048800207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41557OtherBCBS
FLP00626704OtherPALMETTO GBA- RR MCARE
FLAK195ZMedicare UPIN