Healthcare Provider Details

I. General information

NPI: 1285629824
Provider Name (Legal Business Name): ANAND VARDHAN KHANDELWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 E WASHINGTON ST STE-2F
MEDINA OH
44256-3332
US

IV. Provider business mailing address

970 E WASHINGTON ST STE-2F
MEDINA OH
44256-3332
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7999
  • Fax: 330-764-9907
Mailing address:
  • Phone: 330-723-7999
  • Fax: 330-764-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51224
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number051224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: