Healthcare Provider Details

I. General information

NPI: 1740777168
Provider Name (Legal Business Name): ANTHONY KHALIFEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # FD-221
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE # FD-221
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-5081
  • Fax: 617-667-5050
Mailing address:
  • Phone: 617-667-5081
  • Fax: 617-667-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301506228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: