Provider Demographics
NPI:1477559607
Name:KHOJA, ISAM AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAM
Middle Name:AHMED
Last Name:KHOJA
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 1:201 STATE ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:814-877-5330
Mailing Address - Fax:814-877-5331
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-5330
Practice Address - Fax:814-877-5331
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 417953207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018743070002Medicaid
PA0018743070002Medicaid