Provider Demographics
NPI:1457474272
Name:KHOSLA, JADA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JADA
Middle Name:MARIE
Last Name:KHOSLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:195 VINCENT FLATS RD
Mailing Address - Street 2:
Mailing Address - City:EAST MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05651-4070
Mailing Address - Country:US
Mailing Address - Phone:646-361-2659
Mailing Address - Fax:
Practice Address - Street 1:147 STATE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3301
Practice Address - Country:US
Practice Address - Phone:802-321-3692
Practice Address - Fax:833-450-5181
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00172612084P0800X
WI164-3202084P0800X
MN639692084P0800X
NY2351322084P0800X
WAMD608705242084P0800X
ORMD1872632084P0800X
TXR71292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry