Provider Demographics
NPI:1255306643
Name:KHANANI, SALEEM A (MD)
Entity Type:Individual
Prefix:
First Name:SALEEM
Middle Name:A
Last Name:KHANANI
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 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3168
Mailing Address - Fax:508-368-3166
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 385
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3168
Practice Address - Fax:508-368-3166
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79814207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5420027OtherUS HEALTHCARE
J16228OtherBLUE CARE ELECT
1050340OtherFIRST HEALTH
3133184OtherHEALTHY START
3000106OtherEVERCARE
784227OtherMVP HEALTH CARE
91688OtherFALLON COMM HEALTH PLAN
AA2308OtherHARVARD PILGRIM HLTHCARE
J16228OtherBLUE SHIELD HMO BLUE
J16228OtherBLUE SHIELD INDEMNITY
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYST
MA3133184Medicaid
5420027OtherAETNA
A20436OtherMEDICARE B
3133184OtherMEDICAID WELFARE
4207375OtherCIGNA HEALTH PLAN
042472266OtherHEALTHCARE VALUE MGMT
042472266OtherONE HEALTH PLAN
MA3133184Medicaid