Provider Demographics
NPI:1245551696
Name:KHALED A. YEHIA MD
Entity type:Organization
Organization Name:KHALED A. YEHIA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL BILLING SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANSUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-253-8987
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-0001
Mailing Address - Country:US
Mailing Address - Phone:781-338-7248
Mailing Address - Fax:781-338-7756
Practice Address - Street 1:178 SAVIN ST STE 500
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2329
Practice Address - Country:US
Practice Address - Phone:781-338-7248
Practice Address - Fax:781-338-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3139174Medicaid
MAJ06698Medicare PIN