Provider Demographics
NPI:1679708234
Name:KHANAL, KRISHNA PRASAD (MBBS MD CAQSM FAAFP)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:PRASAD
Last Name:KHANAL
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Gender:M
Credentials:MBBS MD CAQSM FAAFP
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Mailing Address - Street 1:1901 VETERAN MEMORIAL DR
Mailing Address - Street 2:BUILDING # 163
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504
Mailing Address - Country:US
Mailing Address - Phone:800-423-2111
Mailing Address - Fax:254-743-0135
Practice Address - Street 1:2094 ALBANY POST RD
Practice Address - Street 2:BUILDING # 3
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1454
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:845-452-6516
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2020-06-04
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Provider Licenses
StateLicense IDTaxonomies
IA39700207Q00000X
NY275691207QS0010X
CAA 121654207QS0010X
IL036.130459207QS0010X
TXS3832207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine