Provider Demographics
NPI:1720085681
Name:KHANOLKAR, ROHIT (MD)
Entity Type:Individual
Prefix:
First Name:ROHIT
Middle Name:
Last Name:KHANOLKAR
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 1:316 S. MCCASKEY RD.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-2150
Mailing Address - Country:US
Mailing Address - Phone:252-792-0022
Mailing Address - Fax:252-792-0027
Practice Address - Street 1:316 S. MCCASKEY RD.
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2150
Practice Address - Country:US
Practice Address - Phone:252-792-0022
Practice Address - Fax:252-792-0027
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15680RL207R00000X
NC2008-01344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911164Medicaid
LA1469238Medicaid
LA4H318Medicare ID - Type Unspecified
LA1469238Medicaid
4H318F973Medicare Oscar/Certification
LAI24747Medicare UPIN
LA4H318Medicare PIN
LA124747Medicare UPIN
NC5911164Medicaid