Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD-417448 | PA |
N | 111NI0900X | Internist | MD-417448 | PA |
N | 207RC0200X | Critical Care Medicine | MD417448 | PA |
Y | 207RP1001X | Pulmonary Disease | 25MA07901200 | NJ |
N | 207RP1001X | Pulmonary Disease | MD417448 | PA |
N | 207RS0012X | Sleep Medicine | MD-417448 | PA |
NPI | 1023122306 |
---|---|
Provider Name | Hussein Kiliddar |
First Address | Camden, NJ 08103-1088 |
Second Address | Woodstown, NJ 08098-1417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100819671 0002 | (05) | PA |
I27717 | (02) | PA |