Healthcare Provider Details

I. General information

NPI: 1952783102
Provider Name (Legal Business Name): WAHID KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERRIMACK ST STE 205
LOWELL MA
01852-1707
US

IV. Provider business mailing address

100 MERRIMACK ST STE 205
LOWELL MA
01852-1707
US

V. Phone/Fax

Practice location:
  • Phone: 978-455-0756
  • Fax:
Mailing address:
  • Phone: 978-710-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: