Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD038265L | PA |
N | 207QA0505X | Family Doctor - Adult Medicine | 25344 | MA |
NPI | 1083604433 |
---|---|
Provider Name | Dr. Mehernosh Pheroze Khan |
First Address | Lenox, MA 01240 |
Second Address | Pittsfield, MA 01201-4109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 23/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008041750009 | (05) | PA |
110093827A | (05) | MA |