Healthcare Provider Details

I. General information

NPI: 1275719759
Provider Name (Legal Business Name): KHALED A SOROUR M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST.
WORCESTER MA
01608
US

IV. Provider business mailing address

15 MILLERS BROOK DRIVE
CUMBERLAND RI
02864
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-5000
  • Fax:
Mailing address:
  • Phone: 401-334-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number208679
License Number StateMA

VIII. Authorized Official

Name: DR. KHALED A SOROUR
Title or Position: OWNER
Credential: M.D.
Phone: 401-334-1324