Provider Demographics
NPI:1699761965
Name:WALI-KHAN, FAUZIA (MD)
Entity type:Individual
Prefix:
First Name:FAUZIA
Middle Name:
Last Name:WALI-KHAN
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 1:61 LINCOLN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:713-893-6214
Mailing Address - Fax:401-414-3486
Practice Address - Street 1:63 EDDIE DOWLING HWY STE 9
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7322
Practice Address - Country:US
Practice Address - Phone:401-414-3485
Practice Address - Fax:401-414-3486
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2193922084P0800X
RIMD169332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110035934AMedicaid
MA2034191Medicaid
MAA36627Medicare ID - Type Unspecified
MA110035934AMedicaid