Provider Demographics
NPI:1417913617
Name:SUDHIR K. KHANNA, M.D., P.C.
Entity Type:Organization
Organization Name:SUDHIR K. KHANNA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLINGSHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-644-0178
Mailing Address - Street 1:239 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-5357
Mailing Address - Country:US
Mailing Address - Phone:570-644-0178
Mailing Address - Fax:570-644-5198
Practice Address - Street 1:239 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5357
Practice Address - Country:US
Practice Address - Phone:570-644-0178
Practice Address - Fax:570-644-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034730L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012673460006Medicaid
PA111925658OtherRAILROAD MEDICARE
PA0012673460006Medicaid
406427Medicare PIN