Healthcare Provider Details

I. General information

NPI: 1649658337
Provider Name (Legal Business Name): CONSTANTINE KHOURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
NORWOOD MA
02062
US

IV. Provider business mailing address

8900 VAN WYCK EXPY
JAMAICA NY
11418-2832
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-4000
  • Fax:
Mailing address:
  • Phone: 718-206-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number276694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: