MEDICARE: MOHEB KHOUZAM, MD

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	207Q00000X	Family Medicine Physician	189174-1	NY
2	207V00000X	Obstetrics & Gynecology Physician	189174-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	189174	OTHER	NY	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912950544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOHEB KHOUZAM, MD

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-0340
Country	:	US
Telephone Number	:	315-732-9368
Fax Number	:	315-732-9403

Provider Business Practice Location Address
First Line	:	135 MAIN ST
Second Line	:
City	:	DELHI
State	:	NY
Zip	:	13753-1219
Country	:	US
Telephone Number	:	607-746-9801
Fax Number	:	607-746-9802

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MOHEB KHOUZAM
Credential	:	MD
Telephone Number	:	607-746-9801

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/07/2023

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