Healthcare Provider Details

I. General information

NPI: 1245611391
Provider Name (Legal Business Name): OLIVIA R. KHOURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E 9TH ST APT 8L
NEW YORK NY
10003-6334
US

IV. Provider business mailing address

63 E 9TH ST APT 8L
NEW YORK NY
10003-6334
US

V. Phone/Fax

Practice location:
  • Phone: 914-310-4775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number298814
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: