Healthcare Provider Details

I. General information

NPI: 1720393077
Provider Name (Legal Business Name): LAITH KHOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5838 SIX FORKS RD
RALEIGH NC
27609-3885
US

IV. Provider business mailing address

5838 SIX FORKS RD
RALEIGH NC
27609-3885
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-3400
  • Fax: 919-783-7778
Mailing address:
  • Phone: 919-785-3400
  • Fax: 919-783-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR2513
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: