Provider Demographics
NPI:1053593699
Name:BACHOUR, KHALED
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:BACHOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL STREET
Mailing Address - Street 2:QUANTUM ONE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1366
Practice Address - Country:US
Practice Address - Phone:724-981-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433256207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102184204Medicaid
PA125736Medicare PIN