Provider Demographics
NPI:1881689727
Name:KHANNA, PARVEEN (MD)
Entity Type:Individual
Prefix:MR
First Name:PARVEEN
Middle Name:
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 W MIDDLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4057
Mailing Address - Country:US
Mailing Address - Phone:860-647-9494
Mailing Address - Fax:860-646-4892
Practice Address - Street 1:43 W MIDDLE TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4057
Practice Address - Country:US
Practice Address - Phone:860-647-9494
Practice Address - Fax:860-646-4892
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028532207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001285320Medicaid
D98314Medicare UPIN
CT060001335Medicare ID - Type Unspecified