Provider Demographics
NPI:1700800687
Name:KHANI, DEBRA ELISE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ELISE
Last Name:KHANI
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 1:10 N GREENE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1524
Mailing Address - Country:US
Mailing Address - Phone:410-605-7000
Mailing Address - Fax:410-605-7192
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7192
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY179666Medicaid
NY176204BJOtherPREFERRED CARE
NY6613OtherBLUE CROSS ROCHESTER
NYP010179666OtherBLUE CHOICE ROCHESTER
NYRA9531Medicare PIN
NYP010179666OtherBLUE CHOICE ROCHESTER