Healthcare Provider Details

I. General information

NPI: 1639225204
Provider Name (Legal Business Name): KHALED EL-SHAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2478
  • Fax: 202-741-2487
Mailing address:
  • Phone: 202-741-2478
  • Fax: 202-741-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD65486
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: