Provider Demographics
NPI:1922166396
Name:KHANNA, ROHIT KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROHIT
Middle Name:KUMAR
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 1:311 N CLYDE MORRIS BLVD STE 550-560
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2781
Mailing Address - Country:US
Mailing Address - Phone:386-255-2340
Mailing Address - Fax:386-258-3284
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 550-560
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2781
Practice Address - Country:US
Practice Address - Phone:386-255-2340
Practice Address - Fax:386-258-3284
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76071207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273565200Medicaid
FL43899Medicare ID - Type Unspecified