Provider Demographics
NPI:1750801312
Name:KAMAR, KHALIL
Entity type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:
Last Name:KAMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 WHITING HILL RD STE 21
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1022
Practice Address - Country:US
Practice Address - Phone:207-973-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-01-24
Deactivation Date:2018-02-01
Deactivation Code:
Reactivation Date:2018-03-01
Provider Licenses
StateLicense IDTaxonomies
MEMD26393207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program