Provider Demographics
NPI:1003102138
Name:KHUMAN, JUGTA (MD)
Entity Type:Individual
Prefix:
First Name:JUGTA
Middle Name:
Last Name:KHUMAN
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 1:50 ISLAND VIEW PL
Mailing Address - Street 2:APT#603
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3272
Mailing Address - Country:US
Mailing Address - Phone:215-687-0833
Mailing Address - Fax:
Practice Address - Street 1:50 ISLAND VIEW PL
Practice Address - Street 2:APT#603
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3272
Practice Address - Country:US
Practice Address - Phone:215-687-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine