Provider Demographics
NPI:1558346106
Name:KHANNA, PARVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVEEN
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 NORMANDY BLVD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-8059
Mailing Address - Country:US
Mailing Address - Phone:904-495-7200
Mailing Address - Fax:904-495-7199
Practice Address - Street 1:10250 NORMANDY BLVD
Practice Address - Street 2:SUITE 703
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8059
Practice Address - Country:US
Practice Address - Phone:904-495-7200
Practice Address - Fax:904-495-7199
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87424207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA693345854BMedicaid
FL71351OtherBLUECROSSBLUESHIELD
FL618395500OtherWORKERS COMPENSATION
FL267353300Medicaid
FL618395500OtherWORKERS COMPENSATION
GA693345854BMedicaid