Healthcare Provider Details

I. General information

NPI: 1083604433
Provider Name (Legal Business Name): MEHERNOSH PHEROZE KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631B NORTH STREET
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

55 PITTSFILED RD
LENOX MA
01240
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-2054
  • Fax: 413-445-9174
Mailing address:
  • Phone: 413-344-1700
  • Fax: 413-728-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25344
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD038265L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: