Provider Demographics
NPI:1932380938
Name:KHERA, GAGAN SINGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAGAN
Middle Name:SINGH
Last Name:KHERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SOUTH ST
Mailing Address - Street 2:HELLER BUILDING ROOM 345
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:781-736-3598
Mailing Address - Fax:781-736-3773
Practice Address - Street 1:415 SOUTH ST
Practice Address - Street 2:HELLER BUILDING ROOM 345
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2728
Practice Address - Country:US
Practice Address - Phone:781-736-3598
Practice Address - Fax:781-736-3773
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical