Provider Demographics
NPI:1730198425
Name:KHOSLA, SUJATA (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:
Last Name:KHOSLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUJATA
Other - Middle Name:
Other - Last Name:KALHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3942 WHITE OAK TRAIL
Mailing Address - Street 2:
Mailing Address - City:ORANGE VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-378-2268
Mailing Address - Fax:
Practice Address - Street 1:7 WEST JACKSON STREET
Practice Address - Street 2:
Practice Address - City:PAINSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.071300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine