Healthcare Provider Details

I. General information

NPI: 1912950544
Provider Name (Legal Business Name): MOHEB KHOUZAM, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAIN ST
DELHI NY
13753-1219
US

IV. Provider business mailing address

PO BOX 340
NEW HARTFORD NY
13413-0340
US

V. Phone/Fax

Practice location:
  • Phone: 607-746-9801
  • Fax: 607-746-9802
Mailing address:
  • Phone: 315-732-9368
  • Fax: 315-732-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number189174-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number189174-1
License Number StateNY

VIII. Authorized Official

Name: MOHEB KHOUZAM
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 607-746-9801