Provider Demographics
NPI:1356354633
Name:KHOURY, LUDWIG E (MD)
Entity type:Individual
Prefix:DR
First Name:LUDWIG
Middle Name:E
Last Name:KHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8086
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13505
Mailing Address - Country:US
Mailing Address - Phone:315-624-7911
Mailing Address - Fax:315-624-7912
Practice Address - Street 1:532 COFFEEN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2421
Practice Address - Country:US
Practice Address - Phone:315-788-1100
Practice Address - Fax:315-788-1188
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241599207K00000X
TXK5132207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02893667Medicaid
NY02893667Medicaid
NYRB3688Medicare PIN