Healthcare Provider Details

I. General information

NPI: 1720923808
Provider Name (Legal Business Name): ISMAIL ARIF KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER STREET ST. VINCENT HOSPITAL
WORCESTER MA
01608
US

IV. Provider business mailing address

123 SUMMER STREET ST. VINCENT HOSPITAL
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-5000
  • Fax:
Mailing address:
  • Phone: 508-363-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3021075
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: