Provider Demographics
NPI:1558326207
Name:KHURANA, SANDEEP (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:KHURANA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2111
Practice Address - Country:US
Practice Address - Phone:570-271-6439
Practice Address - Fax:570-271-6852
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63114207RG0100X, 207RI0008X
PAMD459564207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1558326207Medicaid
MD407629000Medicaid
MD646902-01OtherBLUE CROSS/BLUE SHIELD
MDN487Medicare PIN
MD407629000Medicaid
I16115Medicare UPIN