MEDICARE: ABOUBAKR M KHAIRAT M.D.

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	208600000X	Surgery Physician	0101255407	VA
2	208600000X	Surgery Physician	D0076378	MD
3	208600000X	Surgery Physician	C4512	KY

General Provider Information

NPI Number	:	1720246358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABOUBAKR M KHAIRAT M.D.

Provider Business Mailing Address
First Line	:	11116 MEDICAL CAMPUS RD
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21742-6710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11110 MEDICAL CAMPUS RD STE 147
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21742-6755
Country	:	US
Telephone Number	:	301-714-4350
Fax Number	:	301-714-4353

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	12/02/2025

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