Healthcare Provider Details

I. General information

NPI: 1245551696
Provider Name (Legal Business Name): KHALED A. YEHIA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 SAVIN ST STE 500
MALDEN MA
02148-2329
US

IV. Provider business mailing address

PO BOX 97
MALDEN MA
02148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-7248
  • Fax: 781-338-7756
Mailing address:
  • Phone: 781-338-7248
  • Fax: 781-338-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN C MANSUR
Title or Position: PRESIDENT, MEDICAL BILLING SERVICE
Credential:
Phone: 603-253-8987