Basic Information
| Provider Information | |||||||||
| NPI: | 1184886202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHODOSH | ||||||||
| FirstName: | RITA | ||||||||
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| Credential: | M.D./PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415348 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022415348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002258885 | ||||||||
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| Practice Location | |||||||||
| Address1: | 281 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083345979 | ||||||||
| FaxNumber: | 5083345232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | T289320 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | A105860 | CA | N | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.