Healthcare Provider Details

I. General information

NPI: 1508823717
Provider Name (Legal Business Name): KHALED A SOROUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRE ST ANESTHETICS OF BROCKTON, PC
BROCKTON MA
02302-3308
US

IV. Provider business mailing address

15 MILLERS BROOK DR
CUMBERLAND RI
02864-6158
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7656
  • Fax: 508-941-6345
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD10810
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number208679
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number208679
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD10810
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: