Basic Information
| Provider Information | |||||||||
| NPI: | 1083604433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | MEHERNOSH | ||||||||
| MiddleName: | PHEROZE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 PITTSFILED RD | ||||||||
| Address2: | |||||||||
| City: | LENOX | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133441700 | ||||||||
| FaxNumber: | 4137288790 | ||||||||
| Practice Location | |||||||||
| Address1: | 631B NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134992054 | ||||||||
| FaxNumber: | 4134459174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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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 | 207QA0505X | 25344 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | MD038265L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110093827A | 05 | MA | MEDICAID | 0008041750009 | 05 | PA | MEDICAID |