Provider Demographics
NPI:1356320857
Name:KHANUJA, KARTAR S (MD)
Entity type:Individual
Prefix:DR
First Name:KARTAR
Middle Name:S
Last Name:KHANUJA
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 1:1700 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6625
Mailing Address - Country:US
Mailing Address - Phone:330-392-8700
Mailing Address - Fax:330-393-6074
Practice Address - Street 1:1700 E MARKET ST
Practice Address - Street 2:SUITE 112
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6625
Practice Address - Country:US
Practice Address - Phone:330-392-8700
Practice Address - Fax:330-393-6074
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-10-0107207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329871Medicaid
OHKH0410921Medicare ID - Type Unspecified
OHA75271Medicare UPIN