Provider Demographics
NPI:1538241153
Name:KHANNA, SHIV C (MD)
Entity type:Individual
Prefix:MR
First Name:SHIV
Middle Name:C
Last Name:KHANNA
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 1:214 PACA ST STE B
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2844
Mailing Address - Country:US
Mailing Address - Phone:301-729-2226
Mailing Address - Fax:301-729-1425
Practice Address - Street 1:214 PACA ST STE B
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2844
Practice Address - Country:US
Practice Address - Phone:301-729-2226
Practice Address - Fax:301-729-1425
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD370M509FMedicare PIN
MDG95092Medicare UPIN