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1215377098 NPI number — CARMEN TINA KHORRAM M.D.

NPI Number: 1215377098
Health Care Provider/Practitioner: CARMEN TINA KHORRAM M.D.

Information about “1215377098” NPI (CARMEN TINA KHORRAM M.D.) exists in 1215377098 in HTML format HTML  |  1215377098 in plain Text format TXT  |  1215377098 in PDF (Portable Document Format) PDF  |  1215377098 in an XML format XML  formats.

NPI Number : 1215377098 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215377098",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KHORRAM",
    "FirstName": "CARMEN",
    "MiddleName": "TINA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "255 PROMENADE ST APT 609",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PROVIDENCE",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02908-5776",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "980-322-5885",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "825 CHALKSTONE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PROVIDENCE",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02908-4728",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "980-322-5885",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/26/2013",
    "LastUpdateDate": "09/21/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "19042",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "MD15994",
          "LicenseNumberStateCode": "RI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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