Healthcare Provider Details

I. General information

NPI: 1811160765
Provider Name (Legal Business Name): KHAN CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST # 402
NEWTON MA
02462-1650
US

IV. Provider business mailing address

2000 WASHINGTON ST # 402
NEWTON MA
02462-1650
US

V. Phone/Fax

Practice location:
  • Phone: 617-527-0239
  • Fax: 617-527-0157
Mailing address:
  • Phone: 617-527-0239
  • Fax: 617-527-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number31809
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number31809
License Number StateMA

VIII. Authorized Official

Name: DR. NASIR A KHAN
Title or Position: OWNER
Credential: MD
Phone: 617-527-0239