Individual
JILA KHORSAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 CHALKSTONE AVE, ROGER WILLIAMS MEDICAL CENTER/PATHOLOGY DEPT, PROVIDENCE, RI 02908-4728
(401) 456-2162
(401) 456-2131
Mailing address
825 CHALKSTONE AVE, ROGER WILLIAMS MEDICAL CENTER/PATHOLOGY DEPT, PROVIDENCE, RI 02908-4728
(401) 456-2162
(401) 456-2131
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD06937
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7002031
—
RI
Enumeration date
08/14/2006
Last updated
07/08/2007
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