Provider Demographics
NPI:1356541486
Name:SMITH KHANNA, NICOLA JOY (MD)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:JOY
Last Name:SMITH KHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:JOY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1391
Mailing Address - Country:US
Mailing Address - Phone:781-383-8380
Mailing Address - Fax:
Practice Address - Street 1:223 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1391
Practice Address - Country:US
Practice Address - Phone:781-383-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235642208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA607592OtherSMS