1245551696 NPI number — KHALED A. YEHIA MD

Table of content: DR. TYLER T LANNING D.C. (NPI 1386016665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245551696 NPI number — KHALED A. YEHIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHALED A. YEHIA MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245551696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-338-7248
Provider Business Mailing Address Fax Number:
781-338-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
178 SAVIN ST STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALDEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02148-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-338-7248
Provider Business Practice Location Address Fax Number:
781-338-7756
Provider Enumeration Date:
06/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MANSUR
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT, MEDICAL BILLING SERVICE
Authorized Official Telephone Number:
603-253-8987

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3139174 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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