Provider Demographics
NPI:1225035165
Name:KHOSLA, AMIT (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:KHOSLA
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 1:8415 BELLONA LN
Mailing Address - Street 2:SUITE 216
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2055
Mailing Address - Country:US
Mailing Address - Phone:410-821-5444
Mailing Address - Fax:410-821-5515
Practice Address - Street 1:8415 BELLONA LN
Practice Address - Street 2:SUITE 216
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2055
Practice Address - Country:US
Practice Address - Phone:410-821-5444
Practice Address - Fax:410-821-5515
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD57357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD182146OtherCOVENTRY
MD129487OtherAETNA U.S. HEALTHCARE INC
MD10182OtherKAISER PERMANENTE
MD129487OtherAETNA U.S. HEALTHCARE INC
G87291Medicare UPIN