Provider Demographics
NPI:1255568598
Name:KHANDHERIA, PARAS (MD)
Entity type:Individual
Prefix:DR
First Name:PARAS
Middle Name:
Last Name:KHANDHERIA
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:PO BOX 29441
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0441
Mailing Address - Country:US
Mailing Address - Phone:210-616-7700
Mailing Address - Fax:210-616-7709
Practice Address - Street 1:8401 DATAPOINT DR STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5907
Practice Address - Country:US
Practice Address - Phone:210-616-7796
Practice Address - Fax:210-616-7799
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ44432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01516834OtherRAILROAD MEDICARE
TX3485351-03Medicaid
TXQ4443OtherTEXAS MEDICAL LICENSE
TX3485351-01Medicaid
TX3485351-02Medicaid
TXP01516462OtherRAILROAD MEDICARE
TXP01516834OtherRAILROAD MEDICARE
TXQ4443OtherTEXAS MEDICAL LICENSE