Provider Demographics
NPI:1447356241
Name:DAHDAH, KHALIL B (MD)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:B
Last Name:DAHDAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BUTLER FARM RD
Mailing Address - Street 2:STE. I
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1564
Mailing Address - Country:US
Mailing Address - Phone:757-766-6080
Mailing Address - Fax:757-766-6085
Practice Address - Street 1:501 BUTLER FARM RD
Practice Address - Street 2:STE. I
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1564
Practice Address - Country:US
Practice Address - Phone:757-766-6080
Practice Address - Fax:757-766-6085
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057037207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5877466Medicaid
VA00V016P83Medicare ID - Type Unspecified
VAG96991Medicare UPIN