Provider Demographics
NPI:1184603631
Name:KHAWAJA, YOUSSEF (MD)
Entity type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CORNERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1551
Mailing Address - Country:US
Mailing Address - Phone:860-621-9353
Mailing Address - Fax:860-621-1815
Practice Address - Street 1:16 CORNERSTONE CT
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1551
Practice Address - Country:US
Practice Address - Phone:860-621-9353
Practice Address - Fax:860-621-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033533207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001335331Medicaid
CT001335331Medicaid
CT110006212Medicare ID - Type UnspecifiedPROVIDER NUMBER