Provider Demographics
NPI:1457357295
Name:KHOURY, ZIAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ZIAD
Middle Name:
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6527
Mailing Address - Country:US
Mailing Address - Phone:814-201-2309
Mailing Address - Fax:814-201-2389
Practice Address - Street 1:1915 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6527
Practice Address - Country:US
Practice Address - Phone:814-201-2309
Practice Address - Fax:814-201-2389
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053122L207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015090710009Medicaid
PAF86033Medicare UPIN
PA0015090710009Medicaid