Provider Demographics
NPI:1568660462
Name:KHANNA, AMIT (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 GERMANTOWN AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2722
Mailing Address - Country:US
Mailing Address - Phone:215-248-8887
Mailing Address - Fax:215-836-5372
Practice Address - Street 1:8815 GERMANTOWN AVE STE 22
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-836-5120
Practice Address - Fax:215-836-2852
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67360208C00000X
PAMD437493208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery