Provider Demographics
NPI:1023540572
Name:KHALID, MOWYAD OMER ELAMIN (MD)
Entity type:Individual
Prefix:
First Name:MOWYAD
Middle Name:OMER ELAMIN
Last Name:KHALID
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 1:526 BLOOMFIELD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5525
Mailing Address - Country:US
Mailing Address - Phone:973-547-3514
Mailing Address - Fax:973-228-2104
Practice Address - Street 1:526 BLOOMFIELD AVE STE 203
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5525
Practice Address - Country:US
Practice Address - Phone:973-547-3514
Practice Address - Fax:973-228-2104
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481393207RR0500X
NJ25MA11822500207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology