Provider Demographics
NPI:1013991926
Name:KHURSHID, HUMERA (MD)
Entity Type:Individual
Prefix:
First Name:HUMERA
Middle Name:
Last Name:KHURSHID
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 1:593 EDDY ST
Mailing Address - Street 2:APC MAIN
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-5435
Mailing Address - Fax:401-444-5256
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC MAIN
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5435
Practice Address - Fax:401-444-5256
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11235207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003281Medicaid
RI119003281Medicare ID - Type UnspecifiedMEDICARE
RIH99624Medicare UPIN
RI007058457Medicare PIN