Provider Demographics
NPI:1770506933
Name:KHAN, RABAB (MD)
Entity Type:Individual
Prefix:
First Name:RABAB
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BOLTON STREET
Mailing Address - Street 2:MARLBORO PEDIATRICS
Mailing Address - City:MARLBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-460-9670
Mailing Address - Fax:
Practice Address - Street 1:320 BOLTON STREET
Practice Address - Street 2:MARLBORO PEDIATRICS
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-460-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ16869OtherBCBS
MAB10181101OtherCIGNA
MA3156541Medicaid
MA151064OtherTUFTS
MA201500OtherHARVARD PILGRIM