Provider Demographics
NPI:1356478747
Name:KHANNA, INDIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:
Last Name:KHANNA
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 1:106 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1277
Mailing Address - Country:US
Mailing Address - Phone:610-825-6525
Mailing Address - Fax:
Practice Address - Street 1:1001 STERIGERE ST
Practice Address - Street 2:NORRISTOWN STATE HOSPITAL
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-5300
Practice Address - Country:US
Practice Address - Phone:610-313-1000
Practice Address - Fax:610-313-1013
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-028672-E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALIC #MD-028672-EOtherLIC
PALIC #MD-028672-EOtherLIC
PAUPIN F14068Medicare UPIN
PAMED PIN 706863KKBMedicare PIN