Provider Demographics
NPI:1205083359
Name:KHALIL, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KHALIL
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:PO BOX 602
Mailing Address - Street 2:65 REDDING RD
Mailing Address - City:GEORGETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06829-0602
Mailing Address - Country:US
Mailing Address - Phone:646-455-1900
Mailing Address - Fax:
Practice Address - Street 1:7 OLD SHERMAN TPKE STE 102
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4174
Practice Address - Country:US
Practice Address - Phone:646-455-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT425392084B0040X
NY2614672084B0040X
CT0425392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400000681 - C00814Medicare PIN