Provider Demographics
NPI:1275789430
Name:NAGARSHETH, KHANJAN H (MD)
Entity Type:Individual
Prefix:
First Name:KHANJAN
Middle Name:H
Last Name:NAGARSHETH
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 1:22 S GREENE ST STE 10B100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-5840
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST STE 240
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7004
Practice Address - Country:US
Practice Address - Phone:410-328-5840
Practice Address - Fax:410-328-0717
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA097529002086S0102X, 2086S0127X, 2086S0129X
PAMD4462662086S0129X
MDD845372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103799788Medicaid