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General NPI Number Information
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NPI Number | 1508823717
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Entity Type | Individual
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Provider Name | KHALED A SOROUR MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 680 CENTRE ST ANESTHETICS OF BROCKTON, PC
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City | BROCKTON
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State | MA
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Zip | 02302-3308
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Country | US
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Telephone | 508-941-7656
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Fax | 508-941-6345
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Provider Business Mailing Address
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Address Line | 15 MILLERS BROOK DR
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City | CUMBERLAND
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State | RI
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Zip | 02864-6158
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD10810
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 208679
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 208679
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | MD10810
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License Number State | RI
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