Provider Demographics
NPI:1184847246
Name:BORIS KHARITON MD PC
Entity Type:Organization
Organization Name:BORIS KHARITON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARITON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-667-5535
Mailing Address - Street 1:PO BOX 411091
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-3091
Mailing Address - Country:US
Mailing Address - Phone:314-667-5535
Mailing Address - Fax:314-261-5010
Practice Address - Street 1:70 JUNGERMANN CIR STE 302
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1637
Practice Address - Country:US
Practice Address - Phone:314-667-5535
Practice Address - Fax:314-261-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00621694 & DN4816OtherRAILROAD MEDICARE OF ILLINOIS
MO250013745 & DN4815OtherRAILROAD MEDICARE OF MISSOURI
IL607509141Medicaid
MO204975718Medicaid
IL607509141Medicaid
MO250013745 & DN4815OtherRAILROAD MEDICARE OF MISSOURI
MO204975718Medicaid