Provider Demographics
NPI:1730528159
Name:AL-KHALILI, YASIR (MD)
Entity type:Individual
Prefix:
First Name:YASIR
Middle Name:
Last Name:AL-KHALILI
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 1:3514 LANCASTER AVE
Mailing Address - Street 2:UNIT 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4917
Mailing Address - Country:US
Mailing Address - Phone:571-419-0350
Mailing Address - Fax:
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:434-584-2273
Practice Address - Fax:434-584-5543
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012655792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology