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General NPI Number Information
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NPI Number | 1497706691
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Entity Type | Organization
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Legal Business Name | THE SKIN & LASER SURGERY CENTER OF NE
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 74 ALLDS ST
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City | NASHUA
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State | NH
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Zip | 03060-4757
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Country | US
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Telephone | 603-886-5506
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Fax | 603-594-2585
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Provider Business Mailing Address
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Address Line | 74 ALLDS ST
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City | NASHUA
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State | NH
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Zip | 03060-4745
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Country | US
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Telephone | 603-886-5506
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Fax | 603-594-2585
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Authorized Official
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Title or Position | OWNER
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Name | KHALIL A KHATRI
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Credential | M.D.
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Telephone | 603-886-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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