Provider Demographics
NPI:1922077841
Name:KHOYRATTY, BIBI S (MD)
Entity Type:Individual
Prefix:
First Name:BIBI
Middle Name:S
Last Name:KHOYRATTY
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 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:22 ST PAUL DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1036
Practice Address - Country:US
Practice Address - Phone:717-217-6020
Practice Address - Fax:717-857-2521
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454133207RH0003X, 207RX0202X
MN43188207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3600118OtherMEDICA
MN050975200Medicaid
11097465OtherCAQH
MN150755OtherUCARE MN
WI34054900Medicaid
MN01026133OtherPREFERREDONE
MN1103540OtherAMERICA'S PPO
MN56B42KHOtherBLUE CROSS BLUE SHIELD MN
PA103013883Medicaid
IN200447160Medicaid
MNHP31134OtherHEALTHPARTNERS
IN200447160Medicaid