Healthcare Provider Details

I. General information

NPI: 1831431618
Provider Name (Legal Business Name): EUGENE KHANDROS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YEVGENIY KHANDROS

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 11/15/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4395
US

IV. Provider business mailing address

3615 CIVIC CENTER BLVD ABRAMSON RESEARCH CENTER 315A
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3535
  • Fax: 267-426-9892
Mailing address:
  • Phone: 215-590-3535
  • Fax: 267-426-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMT210281
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: