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1366862104 NPI number — HANAN KHAIRALLA MD

NPI Number: 1366862104
Health Care Provider/Practitioner: HANAN KHAIRALLA MD

Information about “1366862104” NPI (HANAN KHAIRALLA MD) exists in 1366862104 in HTML format HTML  |  1366862104 in plain Text format TXT  |  1366862104 in PDF (Portable Document Format) PDF  |  1366862104 in an XML format XML  formats.

NPI Number : 1366862104 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366862104",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KHAIRALLA",
    "FirstName": "HANAN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "143 NEWBURY ST",
    "SecondLineMailingAddress": "ST 400",
    "MailingAddressCityName": "BOSTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02116-2925",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "781-354-1872",
    "MailingAddressFaxNumber": "430-206-2273",
    "FirstLinePracticeLocationAddress": "143 NEWBURY ST STE 400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOSTON",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "02116-2954",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "781-354-1872",
    "PracticeLocationAddressFaxNumber": "430-206-2273",
    "EnumerationDate": "04/20/2014",
    "LastUpdateDate": "03/05/2026",
    "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": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "25MA10189700",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "277009",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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