Provider Demographics
NPI:1003891672
Name:KHERA, MAHENDRA SINGH (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:SINGH
Last Name:KHERA
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 1:1425 LIBERTY RD
Mailing Address - Street 2:SUITE # 216
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6420
Mailing Address - Country:US
Mailing Address - Phone:443-609-4623
Mailing Address - Fax:443-609-4627
Practice Address - Street 1:1425 LIBERTY ROAD
Practice Address - Street 2:SUITE # 216
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6420
Practice Address - Country:US
Practice Address - Phone:443-609-4623
Practice Address - Fax:443-609-4627
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD427662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF45605Medicare UPIN
MD040QMedicare ID - Type Unspecified
MD182821500Medicare ID - Type Unspecified