Healthcare Provider Details

I. General information

NPI: 1699761965
Provider Name (Legal Business Name): FAUZIA WALI-KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 EDDIE DOWLING HWY STE 9
NORTH SMITHFIELD RI
02896-7322
US

IV. Provider business mailing address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

V. Phone/Fax

Practice location:
  • Phone: 401-414-3485
  • Fax: 401-414-3486
Mailing address:
  • Phone: 713-893-6214
  • Fax: 401-414-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number219392
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD16933
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: