Provider Demographics
NPI:1063470458
Name:KHACHADOORIAN-ELIA, HOLLY R (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:KHACHADOORIAN-ELIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:381 HIGH ROCK ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1540
Mailing Address - Country:US
Mailing Address - Phone:781-405-6499
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - Street 2:55 FRUIT STREET - FOUNDERS 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-2640
Practice Address - Fax:617-726-4267
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227474207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology