Healthcare Provider Details

I. General information

NPI: 1760446082
Provider Name (Legal Business Name): FARIDOON KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CASS AVE SUITE J
WOONSOCKET RI
02895-4741
US

IV. Provider business mailing address

219 CASS AVE SUITE J
WOONSOCKET RI
02895-4741
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-7956
  • Fax: 401-765-7959
Mailing address:
  • Phone: 401-766-7956
  • Fax: 401-765-7959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number3904
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: