Healthcare Provider Details

I. General information

NPI: 1174546527
Provider Name (Legal Business Name): FAUZI RAIF KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MOUNT HERMON RD STE 9A
SALISBURY MD
21804
US

IV. Provider business mailing address

1325 MOUNT HERMON RD STE 9A
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-6833
  • Fax: 410-749-5139
Mailing address:
  • Phone: 410-749-6833
  • Fax: 410-749-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD38647
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: