Individual
KHAULA KHATLANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
975 FARMINGTON AVE STE 1, BRISTOL, CT 06010-3964
(860) 589-0114
(860) 589-1936
Mailing address
975 FARMINGTON AVE STE 1, BRISTOL, CT 06010-3964
(860) 589-0114
(860) 589-1936
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
66471
CT
208600000X
Surgery Physician
4301096855
MI
390200000X
Student in an Organized Health Care Education/Training Program
57453
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
66471
STATE LICENSE
CT
Enumeration date
08/25/2010
Last updated
09/21/2020
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