Healthcare Provider Details

I. General information

NPI: 1780979963
Provider Name (Legal Business Name): MUHAMMAD OMER KHOKHAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LIBBY ST
BROCKTON MA
02302-2949
US

IV. Provider business mailing address

111 CONTINENTAL DRIVE, SUITE 406 IPC-THE HOSPITALIST COMPANY.
NEWARK DE
19713-8112
US

V. Phone/Fax

Practice location:
  • Phone: 844-604-4673
  • Fax: 508-941-6117
Mailing address:
  • Phone: 302-984-2577
  • Fax: 302-368-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number312574
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1018554
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: