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General NPI Number Information
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NPI Number | 1922552967
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Entity Type | Organization
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Legal Business Name | KHALED MOHAMED, MD LLC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 35 OLD TAVERN RD SUITE 101
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City | ORANGE
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State | CT
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Zip | 06477-3450
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Country | US
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Telephone | 914-830-0813
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Fax | 203-717-0138
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Provider Business Mailing Address
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Address Line | 35 OLD TAVERN RD SUITE 101
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City | ORANGE
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State | CT
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Zip | 06477-3450
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Country | US
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Telephone | 914-830-0813
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Fax | 203-717-0138
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Authorized Official
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Title or Position | OWNER
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Name | KHALED MOHAMED
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Credential | MD
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Telephone | 914-682-0965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 47217
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License Number State | CT
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