Provider Demographics
NPI:1518008580
Name:KHANNA, MANISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
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 1:344 TSCHIFFELY SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5682
Mailing Address - Country:US
Mailing Address - Phone:518-542-3037
Mailing Address - Fax:202-379-9225
Practice Address - Street 1:2021 K ST NW STE 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:702-488-0842
Practice Address - Fax:202-379-9225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98600207Y00000X
DCMD046548207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty