Provider Demographics
NPI:1033169610
Name:KHATRI, KHALIL A (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:A
Last Name:KHATRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 ALLDS ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4757
Mailing Address - Country:US
Mailing Address - Phone:603-886-5506
Mailing Address - Fax:603-594-2585
Practice Address - Street 1:6 COURTHOUSE LN UNIT 7
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1725
Practice Address - Country:US
Practice Address - Phone:978-453-5559
Practice Address - Fax:978-453-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74628207N00000X
NH9870207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
074628OtherTUFTS HEALTH PLAN
4126925OtherMVP HEALTHCARE
B20757401OtherCIGNA
NH449040OtherHEALTHSOURCE
NHE96008OtherHARVARD PILGRIM
070011655OtherRAILROAD MEDICARE
5521687OtherAETNA
MA4845OtherHARVARD PILGRIM
NH0100874Y0NH01OtherANTHEM NH
0300219OtherUNITED HEALTH
MAJ11516OtherBLUE CROSS BLUE SHIELD
MAJ11516OtherBLUE CROSS BLUE SHIELD
NHE96008OtherHARVARD PILGRIM
070011655OtherRAILROAD MEDICARE