Basic Information
| Provider Information | |||||||||
| NPI: | 1861806192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | QAISER | ||||||||
| MiddleName: | SHAMSHIR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 LAKE AVE N # S7-831 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016550002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088561256 | ||||||||
| FaxNumber: | 5088566426 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 LAKE AVE N # S7-831 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088561256 | ||||||||
| FaxNumber: | 5088566426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2014 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0802X | 274343 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry |
No ID Information.