Provider Demographics
NPI:1356345193
Name:KHALIGHI, KOROUSH (MD)
Entity type:Individual
Prefix:
First Name:KOROUSH
Middle Name:
Last Name:KHALIGHI
Suffix:
Gender:
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 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:122 WYOMING STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2731
Practice Address - Country:US
Practice Address - Phone:937-223-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056515207RC0000X, 207UN0901X
PAMD066096-L207RC0000X
NJ25MA068440207RC0001X
WI102020207RC0001X
PAMD041360-L207UN0901X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2026901OtherCAPITAL BLUE CROSS
PA674485OtherKEYSTONE CAPITAL
PA9051056OtherCIGNA PA
PAP718311OtherOXFORD
PA1459106OtherHIGHMARK PA
PA563332OtherAETNA US HEALTHCARE
PA20010114Medicaid
NJ674485OtherHIGHMARK NJ
PA1580148Medicaid
NJ4643704Medicaid
PA1459106OtherHIGHMARK PA
PAP718311OtherOXFORD
NJ029876M9RMedicare PIN