=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083869234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHALIL RAFIQ ALSHAER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2008
-----------------------------------------------------
Last Update Date | 04/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 TROY SCHENECTADY RD SUITE 102
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-783-3110
-----------------------------------------------------
Fax | 518-782-7988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 TROY SCHENECTADY RD SUITE 203
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-782-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 260323
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------