Provider Demographics
NPI:1750460614
Name:AIZOOKY, KHATTAR (MD)
Entity Type:Individual
Prefix:
First Name:KHATTAR
Middle Name:
Last Name:AIZOOKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 TECHNOLOGY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9531
Mailing Address - Country:US
Mailing Address - Phone:412-531-2902
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:1 FORSYTHE RD STE 2
Practice Address - Street 2:
Practice Address - City:PRESTO
Practice Address - State:PA
Practice Address - Zip Code:15142-1170
Practice Address - Country:US
Practice Address - Phone:412-276-3050
Practice Address - Fax:412-276-5393
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD069313L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017886750001Medicaid
PA777478Medicare ID - Type Unspecified
PA0017886750001Medicaid