Provider Demographics
NPI:1174332365
Name:AKTER, KHADIJA
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:
Last Name:AKTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SUGARLOAF TRL APT 1206
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-7487
Mailing Address - Country:US
Mailing Address - Phone:469-588-1501
Mailing Address - Fax:
Practice Address - Street 1:331 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1201
Practice Address - Country:US
Practice Address - Phone:315-725-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP133124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine