Basic Information
| Provider Information | |||||||||
| NPI: | 1285861401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHATEEB | ||||||||
| FirstName: | FAHAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 SETON CENTER PKWY | ||||||||
| Address2: | STE 215 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241864 | ||||||||
| FaxNumber: | 5124199016 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663969344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Q0659 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 25MA10681900 | NJ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.