Provider Demographics
NPI:1902283039
Name:KHAWAR KHURSHID M D A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KHAWAR KHURSHID M D A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHURSHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-591-0808
Mailing Address - Street 1:112 JAX SQ
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-3321
Mailing Address - Country:US
Mailing Address - Phone:646-591-0808
Mailing Address - Fax:
Practice Address - Street 1:112 JAX SQ
Practice Address - Street 2:
Practice Address - City:STERLINGTON
Practice Address - State:LA
Practice Address - Zip Code:71280-3321
Practice Address - Country:US
Practice Address - Phone:646-591-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206317207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty