Provider Demographics
NPI:1922552967
Name:KHALED MOHAMED, MD LLC
Entity Type:Organization
Organization Name:KHALED MOHAMED, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-682-0965
Mailing Address - Street 1:35 OLD TAVERN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3450
Mailing Address - Country:US
Mailing Address - Phone:914-830-0813
Mailing Address - Fax:203-717-0138
Practice Address - Street 1:35 OLD TAVERN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3450
Practice Address - Country:US
Practice Address - Phone:914-830-0813
Practice Address - Fax:203-717-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT472172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1124049861OtherNPI TYPE 1