Healthcare Provider Details

I. General information

NPI: 1669944237
Provider Name (Legal Business Name): KHALED ADIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3412
US

IV. Provider business mailing address

49 SHERIDAN AVE APT 203
ALBANY NY
12210-2705
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3368
  • Fax:
Mailing address:
  • Phone: 514-803-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number293471
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301505747
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: