Healthcare Provider Details

I. General information

NPI: 1497733547
Provider Name (Legal Business Name): RAZIB KHAUND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2006
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUTLER DR
PROVIDENCE RI
02906-4862
US

IV. Provider business mailing address

PO BOX 1119
PROVIDENCE RI
02901-1119
US

V. Phone/Fax

Practice location:
  • Phone: 401-330-1415
  • Fax:
Mailing address:
  • Phone: 401-330-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD08864
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: