Healthcare Provider Details

I. General information

NPI: 1487702718
Provider Name (Legal Business Name): A & S KHANDELWAL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 E WASHINGTON ST STE 2F
MEDINA OH
44256-2181
US

IV. Provider business mailing address

970 E WASHINGTON ST STE 2F
MEDINA OH
44256-2181
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 Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35-054767K
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number051224K
License Number StateOH

VIII. Authorized Official

Name: DR. ANAND V KHANDELWAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-723-7999