Healthcare Provider Details

I. General information

NPI: 1801385984
Provider Name (Legal Business Name): PRATEEK KHANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3466
  • Fax: 617-632-2165
Mailing address:
  • Phone: 877-441-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number1022121
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: