Provider Demographics
NPI:1497733547
Name:KHAUND, RAZIB (MD)
Entity Type:Individual
Prefix:
First Name:RAZIB
Middle Name:
Last Name:KHAUND
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:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-330-1415
Mailing Address - Fax:
Practice Address - Street 1:100 BUTLER DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4862
Practice Address - Country:US
Practice Address - Phone:401-330-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08864207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI23279-9OtherBCBS RI
RI005317OtherBLUECHIP
RI691762OtherHPHC
RI7004729Medicaid
RI7004729Medicaid
RI005317OtherBLUECHIP