Healthcare Provider Details

I. General information

NPI: 1104859958
Provider Name (Legal Business Name): VANDANA KHURMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY ML 0563
CINCINNATI OH
45267-0001
US

IV. Provider business mailing address

3664 ASHWORTH DR UNIT C
CINCINNATI OH
45208-1834
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4701
  • Fax:
Mailing address:
  • Phone: 513-871-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.086374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: