Provider Demographics
NPI:1700928843
Name:DARR, KHALID (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:DARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:
Other - Last Name:DARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5510 PEARL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2550
Mailing Address - Country:US
Mailing Address - Phone:440-842-7602
Mailing Address - Fax:440-842-7605
Practice Address - Street 1:5510 PEARL RD STE 205
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2550
Practice Address - Country:US
Practice Address - Phone:440-842-7602
Practice Address - Fax:440-842-7605
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.032997173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707319Medicaid
OH0624103Medicare PIN
OHC03456Medicare UPIN