Healthcare Provider Details

I. General information

NPI: 1770506933
Provider Name (Legal Business Name): RABAB KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BOLTON STREET MARLBORO PEDIATRICS
MARLBORO MA
01752
US

IV. Provider business mailing address

320 BOLTON STREET MARLBORO PEDIATRICS
MARLBORO MA
01752
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-9670
  • Fax:
Mailing address:
  • Phone: 508-460-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151064
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: