Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 2021-01214 | NC |
N | 2080P0214X | Pediatric Pulmonologist | R75398 | AZ |
NPI | 1548629777 |
---|---|
Provider Name | Nasim Khattab |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2016 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1548629777 | NASIM KHATTAB (01) | |
1548629777 | SELF (01) |