Provider Demographics
NPI:1003672015
Name:KHAIRALLA, GEORGE M
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:KHAIRALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1532
Mailing Address - Country:US
Mailing Address - Phone:978-429-9931
Mailing Address - Fax:
Practice Address - Street 1:313 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1532
Practice Address - Country:US
Practice Address - Phone:978-429-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications