Provider Demographics
NPI:1639256613
Name:KHALLUF, EDGAR G (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:G
Last Name:KHALLUF
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 1:10201 SHERMAN HEIGHTS PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-5416
Mailing Address - Country:US
Mailing Address - Phone:410-740-0349
Mailing Address - Fax:
Practice Address - Street 1:1901 SULPHUR SPRING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2943
Practice Address - Country:US
Practice Address - Phone:410-536-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029030207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD731LJ081Medicare PIN