Basic Information
Provider Information
NPI: 1922415058
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUSARI
FirstName: KHALIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9910 FRANKLIN SQUARE DR STE 2110
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212364902
CountryCode: US
TelephoneNumber: 4109336423
FaxNumber:  
Practice Location
Address1: 600 N WOLFE STREET
Address2: MEYER 2-147
City: BALTIMORE
State: MD
PostalCode: 212870005
CountryCode: US
TelephoneNumber: 4109556070
FaxNumber: 4109550751
Other Information
ProviderEnumerationDate: 07/21/2014
LastUpdateDate: 07/17/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/17/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XD88776MDY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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