Provider Demographics
NPI:1467502401
Name:KHUNTIA, ANJANA (MD)
Entity type:Individual
Prefix:
First Name:ANJANA
Middle Name:
Last Name:KHUNTIA
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 1:470 SENTRY PKWY E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2324
Mailing Address - Country:US
Mailing Address - Phone:610-825-5800
Mailing Address - Fax:610-397-0980
Practice Address - Street 1:470 SENTRY PKWY E
Practice Address - Street 2:SUITE 200
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2324
Practice Address - Country:US
Practice Address - Phone:610-825-5800
Practice Address - Fax:610-397-0980
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361142172080P0201X
PAMD435625207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114217Medicaid