Healthcare Provider Details

I. General information

NPI: 1912792078
Provider Name (Legal Business Name): REEM KHRAISHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REEM O M KHRAISHI MD

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SOUTH 11TH STREET 204 PAVILION
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

117 SOUTH 11TH STREET 204 PAVILION
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-3876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: