Provider Demographics
NPI:1295705630
Name:ZARKOOB, KHADIJEH S (MD)
Entity type:Individual
Prefix:DR
First Name:KHADIJEH
Middle Name:S
Last Name:ZARKOOB
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 1:11919 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-303-9111
Mailing Address - Fax:410-356-4980
Practice Address - Street 1:504 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2439
Practice Address - Country:US
Practice Address - Phone:208-799-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO639052085R0001X
KY511932085R0001X
IDMC-07202085R0001X
OH35C.0002422085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1295705630OtherNPI
MDB07450Medicare UPIN
MDS858N055Medicare PIN