Provider Demographics
NPI:1003804964
Name:KHAROD, AMIT S (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:S
Last Name:KHAROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-308-4202
Mailing Address - Fax:732-308-4212
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-308-4202
Practice Address - Fax:732-308-4212
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068352L208600000X
NJ25MA08240200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018556980001Medicaid
116588W5RMedicare PIN
H51576Medicare UPIN
PA0018556980001Medicaid