Provider Demographics
NPI:1639286297
Name:KHAN, KHALID N (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:N
Last Name:KHAN
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 1:90 BAY COLONY DR
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2511
Mailing Address - Country:US
Mailing Address - Phone:508-279-4682
Mailing Address - Fax:
Practice Address - Street 1:BRIDGEWATER STATE HOSPITAL
Practice Address - Street 2:20 ADMINISTRATION ROAD
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324
Practice Address - Country:US
Practice Address - Phone:508-279-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine