Basic Information
Provider Information
NPI: 1417488420
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KHAN
FirstName: SARAH
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 ALBANY ST FL G
Address2:  
City: BOSTON
State: MA
PostalCode: 021193791
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 72 E NEWTON ST STE 124
Address2:  
City: BOSTON
State: MA
PostalCode: 021182308
CountryCode: US
TelephoneNumber: 6176387253
FaxNumber: 6176386501
Other Information
ProviderEnumerationDate: 03/22/2017
LastUpdateDate: 09/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X282022MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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