Healthcare Provider Details

I. General information

NPI: 1295705630
Provider Name (Legal Business Name): KHADIJEH S. ZARKOOB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 6TH ST
LEWISTON ID
83501-2439
US

IV. Provider business mailing address

11919 PARK HEIGHTS AVE
OWINGS MILLS MD
21117
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-5600
  • Fax:
Mailing address:
  • Phone: 410-303-9111
  • Fax: 410-356-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDOO63905
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number51193
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMC-0720
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number35C.000242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: