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General NPI Number Information
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NPI Number | 1205896495
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Entity Type | Individual
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Provider Name | BORIS KHARITON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 70 JUNGERMANN CIR STE 302
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City | SAINT PETERS
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State | MO
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Zip | 63376-1637
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Country | US
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Telephone | 314-667-5535
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Fax | 314-261-5010
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Provider Business Mailing Address
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Address Line | PO BOX 411091
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City | SAINT LOUIS
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State | MO
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Zip | 63141-3091
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Country | US
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Telephone | 314-667-5535
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Fax | 314-261-5010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 110866
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License Number State | MO
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