Provider Demographics
NPI:1205882966
Name:KHAN, BUSHRA (MD)
Entity type:Individual
Prefix:
First Name:BUSHRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BUSHRA
Other - Middle Name:
Other - Last Name:FAROOQI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:152 CONANT STREET
Mailing Address - Street 2:LAHEY BEVERLY
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2511
Mailing Address - Country:US
Mailing Address - Phone:978-927-1919
Mailing Address - Fax:978-927-6102
Practice Address - Street 1:152 CONANT STREET
Practice Address - Street 2:LAHEY BEVERLY
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2511
Practice Address - Country:US
Practice Address - Phone:978-927-1919
Practice Address - Fax:978-927-6102
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110038108AMedicaid
MAA3650501Medicare PIN