Healthcare Provider Details

I. General information

NPI: 1194957803
Provider Name (Legal Business Name): S. CHARLES KHANI, M.D. PHD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CUMMINGS CTR SUITE 308V
BEVERLY MA
01915-6198
US

IV. Provider business mailing address

47 WALKER RD
MANCHESTER MA
01944-1032
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-1344
  • Fax: 978-922-1346
Mailing address:
  • Phone: 978-922-1344
  • Fax: 978-922-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHROKH CHARLES KHANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-922-1344