Provider Demographics
NPI:1285629824
Name:KHANDELWAL, ANAND VARDHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAND
Middle Name:VARDHAN
Last Name:KHANDELWAL
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 1:970 E WASHINGTON ST
Mailing Address - Street 2:STE-2F
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-723-7999
Mailing Address - Fax:330-764-9907
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:STE-2F
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-723-7999
Practice Address - Fax:330-764-9907
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH051224207RP1001X
OH51224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH051224OtherMEDICAL LICENCE #
OH0667194Medicaid
OHA82692Medicare UPIN
OH0667194Medicaid