Provider Demographics
NPI:1124361662
Name:KHANNA, SURBHI (MBBS)
Entity Type:Individual
Prefix:
First Name:SURBHI
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9841 BROKEN LAND PKWY STE 211
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3068
Mailing Address - Country:US
Mailing Address - Phone:240-708-4334
Mailing Address - Fax:240-708-4153
Practice Address - Street 1:9841 BROKEN LAND PKWY STE 211
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046
Practice Address - Country:US
Practice Address - Phone:443-708-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD850472084P0802X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program