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1417905480

NPI Code Detail

MEDICARE: DR. NAGWA KHADR M.D.

MEDICARE: DR. NAGWA KHADR 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	208000000X	Pediatrics Physician	50618	CT
2	208000000X	Pediatrics Physician	MD453558	PA
3	208000000X	Pediatrics Physician	4301060896	MI
4	208000000X	Pediatrics Physician	ME161425	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	350D410030	OTHER	MI	BCBSM BCN COM BLUE CHOICE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417905480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGWA KHADR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1137
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32902-1137
Country	:	US
Telephone Number	:	321-952-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 SARNO RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3084
Country	:	US
Telephone Number	:	321-241-6800
Fax Number	:	321-241-6890

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/08/2023

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Directions to “ DR. NAGWA KHADR M.D.” Practice Location

Language	Start Address	Practice Location

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