=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366892127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEELAM KHAIRA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2016
-----------------------------------------------------
Last Update Date | 12/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1606 BIRDS FORT TRAIL VIRIDIAN MD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76005-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-427-7208
-----------------------------------------------------
Fax | 480-781-4946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1606 BIRDS FORT TRAIL VIRIDIAN MD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76005-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-427-7208
-----------------------------------------------------
Fax | 480-781-4946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME142035
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | V4688
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------