Healthcare Provider Details

I. General information

NPI: 1922200377
Provider Name (Legal Business Name): EDWARD KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLAND DR
DERRY NH
03038-2746
US

IV. Provider business mailing address

14 CRESTVIEW CIR UNIT 164
LONDONDERRY NH
03053-2489
US

V. Phone/Fax

Practice location:
  • Phone: 603-421-2143
  • Fax: 603-421-2344
Mailing address:
  • Phone: 207-263-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15880
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number017256
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number268905
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: