MEDICARE: KAMAL KHALAF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	IND 038962-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	542187	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568468031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL KHALAF MD

Provider Business Mailing Address
First Line	:	122 ASPEN RD
Second Line	:
City	:	PUNXSUTAWNEY
State	:	PA
Zip	:	15767-2658
Country	:	US
Telephone Number	:	814-938-8263
Fax Number	:	866-832-1744

Provider Business Practice Location Address
First Line	:	81 HILLCREST DR
Second Line	:
City	:	PUNXSUTAWNEY
State	:	PA
Zip	:	15767-2605
Country	:	US
Telephone Number	:	814-938-1836
Fax Number	:	814-938-1834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2013

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