Provider Demographics
NPI:1609827021
Name:SUBRAMANIAN KHURANA, DIVYA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:SUBRAMANIAN KHURANA
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 1:1140 GREENTREE LN
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1218
Mailing Address - Country:US
Mailing Address - Phone:215-427-5470
Mailing Address - Fax:215-427-4393
Practice Address - Street 1:ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - Street 2:ERIE AVENUE AND FRONT STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-427-5470
Practice Address - Fax:215-427-4393
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064264L2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017017440006Medicaid
PAG13194Medicare UPIN
PA0017017440006Medicaid