Healthcare Provider Details

I. General information

NPI: 1073570784
Provider Name (Legal Business Name): MOHAMMAD SOHAIL KHERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SPENCER ST
WINSTED CT
06098-1140
US

IV. Provider business mailing address

115 SPENCER ST
WINSTED CT
06098-1140
US

V. Phone/Fax

Practice location:
  • Phone: 860-738-0400
  • Fax:
Mailing address:
  • Phone: 860-738-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number031662
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: