Provider Demographics
NPI:1114926987
Name:KHURMA, SANTOSH (MD)
Entity Type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:KHURMA
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 N PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2666
Mailing Address - Country:US
Mailing Address - Phone:937-562-2280
Mailing Address - Fax:937-562-2282
Practice Address - Street 1:50 N. PROGRESS DR.
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385
Practice Address - Country:US
Practice Address - Phone:937-374-4041
Practice Address - Fax:937-374-4020
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046068207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00432943OtherRAILROAD MEDICARE
OH0687109Medicaid
OH000000012488OtherANTHEM
OH110089376OtherRAILROAD MEDICARE
OH110089376OtherRAILROAD MEDICARE
OH0687109Medicaid
OHP00432943OtherRAILROAD MEDICARE
OHH370880Medicare PIN