Provider Demographics
NPI:1790889434
Name:KHAVARI, PARIS (MD)
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:KHAVARI
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 1:25 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2841
Mailing Address - Country:US
Mailing Address - Phone:603-431-2516
Mailing Address - Fax:603-431-9945
Practice Address - Street 1:25 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2841
Practice Address - Country:US
Practice Address - Phone:603-431-2516
Practice Address - Fax:603-431-9945
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP01011565OtherRAILROAD MEDICARE
NH3083630Medicaid
D78651Medicare UPIN
NHNH361901Medicare PIN
D78651Medicare UPIN
CT30210770Medicaid