Healthcare Provider Details

I. General information

NPI: 1033582002
Provider Name (Legal Business Name): ABDUL KHALID, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W MILLBROOK RD
RALEIGH NC
27609-4389
US

IV. Provider business mailing address

312 W MILLBROOK RD
RALEIGH NC
27609-4389
US

V. Phone/Fax

Practice location:
  • Phone: 919-648-0241
  • Fax:
Mailing address:
  • Phone: 919-648-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2009-00020
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2009-00020
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ABDUL S KHALID
Title or Position: OWNER
Credential:
Phone: 919-648-0241