Provider Demographics
NPI:1780601443
Name:KHATI-BOUGHANEM, NADIA J (MD)
Entity type:Individual
Prefix:DR
First Name:NADIA
Middle Name:J
Last Name:KHATI-BOUGHANEM
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 1:900 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2342
Mailing Address - Country:US
Mailing Address - Phone:202-715-5154
Mailing Address - Fax:
Practice Address - Street 1:900 23RD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD325332085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKA80OtherB/C B/S
DC2849OtherB/C B/S
MDJ062OtherB/C B/S
MDJ062OtherB/C B/S
MDH33095Medicare UPIN
DEDD4343Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE