Provider Demographics
NPI:1497935936
Name:SHIV C KHANNA MD PA
Entity Type:Organization
Organization Name:SHIV C KHANNA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIV
Authorized Official - Middle Name:C
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-729-2226
Mailing Address - Street 1:214 PACA ST STE B
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2844
Mailing Address - Country:US
Mailing Address - Phone:301-729-2226
Mailing Address - Fax:301-729-1425
Practice Address - Street 1:214 PACA ST STE B
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2844
Practice Address - Country:US
Practice Address - Phone:301-729-2226
Practice Address - Fax:301-729-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG95092Medicare UPIN
MD370MMedicare PIN