| Doctor Name: | DR. ESSAM MOHAMED KHEDR |
| NPI Number: | 1457686487 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 2353 |
| Business Practice Address: | 80 Mechanic Street Athol, MA - 013312133 |
| Business Phone Number: | 9782491295 |
| Business Fax Number: | 9782495669 |
| Mailing Address: | 80 Mechanic Street, ATHOL |
| State: | MA |
| Postal Code: | 013312133 |
| Phone Number: | 9782491295 |
| Fax Number: | 9782495669 |
| NPI Enumeration Date: | 10/08/2009 |
| NPI Last Update Date: | 10/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 2353 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |