1205882966 NPI number — BUSHRA KHAN MD

Table of content: LAUREN ELIZABETH RAKES (NPI 1104512391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205882966 NPI number — BUSHRA KHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
BUSHRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAROOQI
Provider Other First Name:
BUSHRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205882966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
152 CONANT STREET
Provider Second Line Business Mailing Address:
LAHEY BEVERLY
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-927-1919
Provider Business Mailing Address Fax Number:
978-927-6102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 CONANT STREET
Provider Second Line Business Practice Location Address:
LAHEY BEVERLY
Provider Business Practice Location Address City Name:
BEVERLY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01915-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-927-1919
Provider Business Practice Location Address Fax Number:
978-927-6102
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  216721 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110038108A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com