=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275719759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KHALED A SOROUR M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2008
-----------------------------------------------------
Last Update Date | 07/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 SUMMER ST.
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-363-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 MILLERS BROOK DRIVE
-----------------------------------------------------
City | CUMBERLAND
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-334-1324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KHALED A SOROUR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 401-334-1324
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 208679
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------