Provider Demographics
NPI:1538384623
Name:KHAIRY, RAED N (MD)
Entity type:Individual
Prefix:
First Name:RAED
Middle Name:N
Last Name:KHAIRY
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 11450
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:479-709-7447
Mailing Address - Fax:479-709-7446
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:STE. 200
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-709-7447
Practice Address - Fax:479-709-7446
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5575207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200194090AMedicaid
AR168560001Medicaid
AR5H180Medicare PIN