Provider Demographics
NPI:1255610580
Name:KHANDARE, ANUPAMA SHANKAR (MD)
Entity type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:SHANKAR
Last Name:KHANDARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4331
Mailing Address - Country:US
Mailing Address - Phone:240-964-9200
Mailing Address - Fax:
Practice Address - Street 1:1050 W INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4331
Practice Address - Country:US
Practice Address - Phone:240-964-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6550207Q00000X
MDD77284207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine