Provider Demographics
NPI:1770637167
Name:SHEKARCHI, KHALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALIL
Middle Name:
Last Name:SHEKARCHI
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 1:126 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-723-7232
Mailing Address - Fax:401-723-2860
Practice Address - Street 1:126 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-723-7232
Practice Address - Fax:401-723-2860
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03449208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI14623OtherBCBS
RI9001462Medicaid
RI1700537OtherUNITED HEALTHCARE
C90312Medicare UPIN