Provider Demographics
NPI:1902838451
Name:ABDELKADER, KHALED M (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:M
Last Name:ABDELKADER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5559
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA78893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110123294OtherRAILROAD MEDICARE
101941OtherCIGNA
65353OtherHARVARD PILGRIM
MA3124282Medicaid
078893OtherTUFTS COMM HEALTH PLAN
J14737Medicare ID - Type Unspecified
0401554OtherUNITED HEALTH CARE
983534OtherNETWORK HEALTH
732225OtherCONNECTICARE
F93296Medicare UPIN
354784OtherHEALTHSOURCE CMHC
90454OtherFALLON COMM HEALTH PLAN
J14737OtherBLUE CROSS BLUE SHIELD