Healthcare Provider Details

I. General information

NPI: 1477533859
Provider Name (Legal Business Name): KHALED L AMR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6096 E MAIN ST STE 103
COLUMBUS OH
43213-4302
US

IV. Provider business mailing address

6096 E MAIN ST STE 103
COLUMBUS OH
43213-4302
US

V. Phone/Fax

Practice location:
  • Phone: 614-715-1500
  • Fax: 614-751-1501
Mailing address:
  • Phone: 614-751-1500
  • Fax: 614-751-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35087312
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35087312
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35087312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: