Provider Demographics
NPI:1053808501
Name:HARARAH, KHALID (MD)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:HARARAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 E VINE ST STE 16
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5541
Mailing Address - Country:US
Mailing Address - Phone:801-509-9138
Mailing Address - Fax:801-797-0237
Practice Address - Street 1:688 E VINE ST STE 16
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5541
Practice Address - Country:US
Practice Address - Phone:801-509-9138
Practice Address - Fax:801-797-0237
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311812207Q00000X
ORMD211549207Q00000X
UT12424228-1205207QB0002X, 2083P0011X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine