Basic Information
| Provider Information | |||||||||
| NPI: | 1790889434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAVARI | ||||||||
| FirstName: | PARIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 NEW HAMPSHIRE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038012841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034312516 | ||||||||
| FaxNumber: | 6034319945 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 NEW HAMPSHIRE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038012841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034312516 | ||||||||
| FaxNumber: | 6034319945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 06/23/2016 | ||||||||
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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 | 207R00000X | 4309 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01011565 | 01 | NH | RAILROAD MEDICARE | OTHER | 3083630 | 05 | NH | MEDICAID |