Provider Demographics
NPI:1154437150
Name:KHANNA, NARESH KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:NARESH
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 1:901 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3416
Mailing Address - Country:US
Mailing Address - Phone:410-391-8300
Mailing Address - Fax:410-391-8377
Practice Address - Street 1:901 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3416
Practice Address - Country:US
Practice Address - Phone:410-391-8300
Practice Address - Fax:410-391-8377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 27411208600000X, 208D00000X
PAMD 026300 E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD350521900Medicaid
MDB66822Medicare UPIN
MD615RMedicare ID - Type UnspecifiedMY MEDICARE NUMBE