Provider Demographics
NPI:1508865619
Name:KHANNA, RAJESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:KHANNA
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 1:903 NW WASHINGTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6386
Mailing Address - Country:US
Mailing Address - Phone:513-867-9000
Mailing Address - Fax:513-785-3675
Practice Address - Street 1:903 NW WASHINGTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6386
Practice Address - Country:US
Practice Address - Phone:513-867-9000
Practice Address - Fax:513-785-3675
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071725K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003576Medicaid
OHG44043Medicare UPIN
OH0817705Medicare PIN
OH2003576Medicaid