Healthcare Provider Details

I. General information

NPI: 1043131121
Provider Name (Legal Business Name): ABDELHAKIM KHELLAF M.D., C.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASS GENERAL BRIGHAM, 75 FRANCIS STREET, COTRAN 360H DEPT. OF PATHOLOGY
BOSTON MA
02115
US

IV. Provider business mailing address

MASS GENERAL BRIGHAM, 75 FRANCIS STREET, COTRAN 360H DEPT. OF PATHOLOGY
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-4699
  • Fax:
Mailing address:
  • Phone: 617-732-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number3020068
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: