MEDICARE: DR. HOSSAM M KHALIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA06812700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295733970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOSSAM M KHALIL M.D.

Provider Business Mailing Address
First Line	:	233 MIDDLE RD
Second Line	:	SUITE 2
City	:	HAZLET
State	:	NJ
Zip	:	07730-1904
Country	:	US
Telephone Number	:	732-335-0900
Fax Number	:	732-335-8080

Provider Business Practice Location Address
First Line	:	233 MIDDLE RD
Second Line	:	SUITE 2
City	:	HAZLET
State	:	NJ
Zip	:	07730-1904
Country	:	US
Telephone Number	:	732-335-0900
Fax Number	:	732-335-8080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/28/2011

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