1881908119 NPI number — DR. KHALDOON TAREQ HUSNI KHIRFAN MBBS

Table of content: DR. KHALDOON TAREQ HUSNI KHIRFAN MBBS (NPI 1881908119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881908119 NPI number — DR. KHALDOON TAREQ HUSNI KHIRFAN MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHIRFAN
Provider First Name:
KHALDOON
Provider Middle Name:
TAREQ HUSNI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881908119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PROVIDER ENROLLMENT 41 MALL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01805-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 MALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01805-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-744-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2010

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: 207RG0100X , with the licence number:  A140888 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 277080 , 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)