Healthcare Provider Details

I. General information

NPI: 1124244637
Provider Name (Legal Business Name): KHALED IQBAL EL-BADAWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KHALED IQBAL

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE FRNT
MOORESTOWN NJ
08057-3130
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7295
  • Fax: 856-291-8791
Mailing address:
  • Phone: 856-247-7295
  • Fax: 856-291-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301093360
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA08776100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: