Individual provider Active NPI

Fawad Khaliq

  • Internal Medicine Physician
  • Towson, MD
National Provider Identifier
1104289750
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D87600 Issued in MD
Practice address
6565 N Charles St
Ppe 203
Towson, MD 21204-6800
Phone
(443) 849-3760
Fax
(443) 849-8138
NPI assigned
Mar 31, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D87600 MD Primary

Addresses

Primary practice location

6565 N Charles St
Ppe 203
Towson, MD 21204-6800

Mailing address

6565 N Charles St
Ppe 203
Towson, MD 21204-6800
Phone (443) 849-3760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220112001156 TX Practitioner - Internal Medicine 8224312897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

520 Douglas Blvd
Tyler, TX 75702-8307
Phone (903) 593-1721

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas Internal Medicine CurrentSince Feb 14, 2022 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Feb 14, 2022 Accepting new patients

Locations

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

Interoperability endpoints

  • Direct secure messaging: fkhaliq268083@christushealth.direct-ci.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1104289750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 N CHARLES ST",
            "address_2": "PPE 203",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046800",
            "telephone_number": "443-849-3760",
            "fax_number": "443-849-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 N CHARLES ST",
            "address_2": "PPE 203",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046800",
            "telephone_number": "443-849-3760",
            "fax_number": "443-849-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIQ",
        "first_name": "FAWAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-31",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D87600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

Verify at the official NPI Registry.