Provider Demographics
NPI:1952438137
Name:KHAULI, RAJA B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:B
Last Name:KHAULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 KEARNEY RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-2205
Mailing Address - Country:US
Mailing Address - Phone:860-928-1798
Mailing Address - Fax:
Practice Address - Street 1:3 DAG HAMMARSKJOLD PLZ
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2303
Practice Address - Country:US
Practice Address - Phone:860-928-1798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53955204F00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrology