Provider Demographics
NPI:1295442200
Name:HARRIS, KHALIL A (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUSSERE RAIGERINGER STRASSE 12
Mailing Address - Street 2:
Mailing Address - City:AMBERG
Mailing Address - State:BAVARIA
Mailing Address - Zip Code:92224
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 28037
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-8037
Practice Address - Country:US
Practice Address - Phone:170-837-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
1198866OtherNCCPA ID