Healthcare Provider Details

I. General information

NPI: 1437853447
Provider Name (Legal Business Name): ALI NOOR KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN ST STE 13
WORCESTER MA
01610-2478
US

IV. Provider business mailing address

26 QUEEN ST STE 13
WORCESTER MA
01610-2478
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7700
  • Fax:
Mailing address:
  • Phone: 508-860-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1026766
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: