Provider Demographics
NPI:1760601561
Name:KHAZEN, RAMZI WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:RAMZI
Middle Name:WILLIAM
Last Name:KHAZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:50 LEOMINSTER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-2146
Practice Address - Country:US
Practice Address - Phone:978-488-5082
Practice Address - Fax:978-422-5081
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA234869207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2164949Medicaid
MA110072006AMedicaid
MAM20928OtherGROUP MEDICARE #
MA9771476OtherGROUP MEDICAID #
MA110072006AMedicaid