1033169610 NPI number — DR. KHALIL A KHATRI M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033169610 NPI number — DR. KHALIL A KHATRI M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KHATRI

Provider First Name:

KHALIL

Provider Middle Name:

A

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1033169610

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/14/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

74 ALLDS ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NASHUA

Provider Business Mailing Address State Name:

NH

Provider Business Mailing Address Postal Code:

03060-4757

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

603-886-5506

Provider Business Mailing Address Fax Number:

603-594-2585

Provider First Line Business Practice Location Address:

6 COURTHOUSE LN UNIT 7

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CHELMSFORD

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01824-1725

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-453-5559

Provider Business Practice Location Address Fax Number:

978-453-4459

Provider Enumeration Date:

05/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207N00000X , with the licence number:  74628 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207N00000X , with the licence number: 9870 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 074628 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 4126925 . This is a "MVP HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: B20757401 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 449040 . This is a "HEALTHSOURCE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: E96008 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: 070011655 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 5521687 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4845 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0100874Y0NH01 . This is a "ANTHEM NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: 0300219 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: J11516 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".