Provider Demographics
NPI:1821069659
Name:KHANDELWAL, MANOJ (MD, FACC, FSCAI)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:KHANDELWAL
Suffix:
Gender:M
Credentials:MD, FACC, FSCAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 HULMEVILLE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4366
Mailing Address - Country:US
Mailing Address - Phone:610-332-9207
Mailing Address - Fax:215-604-7954
Practice Address - Street 1:3554 HULMEVILLE RD STE 111
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4366
Practice Address - Country:US
Practice Address - Phone:610-332-9207
Practice Address - Fax:215-604-7954
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05176100207RI0011X
PAMD047445L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6284809Medicaid
064295AFEMedicare PIN
B98069Medicare UPIN