Provider Demographics
NPI:1093768897
Name:KHOSLA, SUBHASH (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
Last Name:KHOSLA
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-1934
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:170 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1539
Practice Address - Country:US
Practice Address - Phone:740-446-5129
Practice Address - Fax:740-446-5622
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-32072085R0001X
WV149832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007230OtherANTHEM BCBS
KYP00900234OtherMEDICARE RAILROAD
OH0625685OtherMOLINA MEDICAID
OH0625685Medicaid
OH310971085162OtherCARESOURCE MEDICAID
001714041OtherMOUNTAIN STATE BCBS
WV0124046000Medicaid
OH000000185263OtherUNISON MEDICAID
920000406OtherRR MEDICARE
OH310971085162OtherCARESOURCE MEDICAID
F05127Medicare UPIN
KY0169Medicare PIN
KYP00900234OtherMEDICARE RAILROAD
KYP400033803Medicare PIN