Provider Demographics
NPI:1003963455
Name:KHOURY, ADA CELESTE (MD)
Entity type:Individual
Prefix:DR
First Name:ADA
Middle Name:CELESTE
Last Name:KHOURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-0646
Mailing Address - Country:US
Mailing Address - Phone:828-645-0046
Mailing Address - Fax:828-645-9584
Practice Address - Street 1:12 1/2 WALL ST
Practice Address - Street 2:SUITE Q
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2724
Practice Address - Country:US
Practice Address - Phone:828-645-0046
Practice Address - Fax:828-645-9584
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57200Medicare UPIN
NC2279951AMedicare ID - Type Unspecified