Provider Demographics
NPI:1033704358
Name:KHODEIRY, MOHAMED MAGDY (MD, MSC)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:MAGDY
Last Name:KHODEIRY
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 WASHINGTON PL APT 508
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-4707
Mailing Address - Country:US
Mailing Address - Phone:929-418-9586
Mailing Address - Fax:
Practice Address - Street 1:301 E MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1511
Practice Address - Country:US
Practice Address - Phone:502-588-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PALT000931207W00000X
FL32181207WX0109X
KYFL072207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist