Healthcare Provider Details

I. General information

NPI: 1619467065
Provider Name (Legal Business Name): KHADIJAH BHATTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE WEST SPAN 201
BOSTON MA
02215
US

IV. Provider business mailing address

330 BROOKLINE AVE WEST SPAN 201
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-0362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number292611
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: