Healthcare Provider Details

I. General information

NPI: 1700466620
Provider Name (Legal Business Name): RAVEENA KHANNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SCOTT ADAM RD STE 301
HUNT VALLEY MD
21030-3360
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 410-666-3960
  • Fax: 410-666-3981
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0106947
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: