Provider Demographics
NPI:1700948635
Name:KHALIL, MAGI MAGDI (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MAGI
Middle Name:MAGDI
Last Name:KHALIL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7544 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4299
Practice Address - Country:US
Practice Address - Phone:804-693-9037
Practice Address - Fax:804-693-9486
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249557207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700948635Medicaid
VAP00931952Medicare PIN
VAVV1120AMedicare PIN