Provider Demographics
NPI:1366425522
Name:KHATOON, NASIMA (MD)
Entity type:Individual
Prefix:
First Name:NASIMA
Middle Name:
Last Name:KHATOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2355
Mailing Address - Country:US
Mailing Address - Phone:781-682-4066
Mailing Address - Fax:781-337-9619
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2355
Practice Address - Country:US
Practice Address - Phone:978-946-8230
Practice Address - Fax:978-946-8226
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78689207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3184536Medicaid
MA68737OtherHARVARD PILGRIM
MAJ19452OtherBLUE CROSS BLUE SHIELD
MA2329169OtherAETNA US HEALTH
MA791722OtherTUFTS HEALTH CARE
MAB20961901OtherCIGNA
MAJ19452OtherBLUE CROSS BLUE SHIELD
MA3184536Medicaid