MEDICARE: FAUZIA WALI-KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	219392	MA
2	2084P0800X	Psychiatry Physician	MD16933	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699761965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAUZIA WALI-KHAN MD

Provider Business Mailing Address
First Line	:	61 LINCOLN ST STE 203
Second Line	:
City	:	FRAMINGHAM
State	:	MA
Zip	:	01702-8264
Country	:	US
Telephone Number	:	713-893-6214
Fax Number	:	401-414-3486

Provider Business Practice Location Address
First Line	:	63 EDDIE DOWLING HWY STE 9
Second Line	:
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-7322
Country	:	US
Telephone Number	:	401-414-3485
Fax Number	:	401-414-3486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	03/11/2020

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