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General NPI Number Information
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NPI Number | 1619388980
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Entity Type | Individual
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Provider Name | KHALIL ALSOUTARY MD
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Gender | Male
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 4465 CORDATA PKWY STE B
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City | BELLINGHAM
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State | WA
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Zip | 98226-8037
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Country | US
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Telephone | 360-752-5206
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Fax | 360-752-5653
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Provider Business Mailing Address
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Address Line | 2626 HALPERIN AVE
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City | BRONX
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State | NY
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Zip | 10461-2631
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Country | US
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Telephone | 718-618-0401
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Fax | 347-479-1303
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 295427
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD61550623
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License Number State | WA
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