Provider Demographics
NPI:1205890258
Name:KHALID, AMATUL BASIT (MD)
Entity type:Individual
Prefix:DR
First Name:AMATUL
Middle Name:BASIT
Last Name:KHALID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SLEEPY HOLLOW DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5838
Mailing Address - Country:US
Mailing Address - Phone:302-449-3030
Mailing Address - Fax:302-449-3040
Practice Address - Street 1:124 SLEEPY HOLLOW DR STE 203
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5838
Practice Address - Country:US
Practice Address - Phone:302-449-3030
Practice Address - Fax:302-449-3040
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063751L207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013618880002Medicaid
PA093350G0DOtherPIN
PAG51454Medicare UPIN
O93350G0DMedicare PIN
PA106549Medicare PIN