Provider Demographics
NPI:1508816042
Name:SKIN & LASER SURGERY CENTER OF NEW ENGLAND
Entity Type:Organization
Organization Name:SKIN & LASER SURGERY CENTER OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHATRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-453-5559
Mailing Address - Street 1:74 ALLDS ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-4745
Mailing Address - Country:US
Mailing Address - Phone:603-886-5506
Mailing Address - Fax:603-594-2585
Practice Address - Street 1:6 COURTHOUSE LN
Practice Address - Street 2:SUITE 7
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1724
Practice Address - Country:US
Practice Address - Phone:978-453-5559
Practice Address - Fax:978-453-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0082924OtherAETNA
9427OtherHEALTHSOURCE
MACL6494OtherRAILROAD MEDICARE
MA715100OtherTUFTS HEALTH PLAN
MAM13479OtherBLUE CROSS BLUE SHIELD
9427OtherHEALTHSOURCE