Healthcare Provider Details

I. General information

NPI: 1144221367
Provider Name (Legal Business Name): TAMIM J KHALIQI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/09/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GUTHRIE CORTLAND MEDICAL CENTER 134 HOMER AVE
CORTLAND NY
13045-1206
US

IV. Provider business mailing address

10 SLEEPY HOLLOW LN
NEW HARTFORD NY
13413-9503
US

V. Phone/Fax

Practice location:
  • Phone: 315-939-0409
  • Fax:
Mailing address:
  • Phone: 315-724-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number10006
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number257121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: