Healthcare Provider Details

I. General information

NPI: 1609827021
Provider Name (Legal Business Name): DIVYA SUBRAMANIAN KHURANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN ERIE AVENUE AND FRONT STREET
PHILADELPHIA PA
19134
US

IV. Provider business mailing address

1140 GREENTREE LN
NARBERTH PA
19072-1218
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-5470
  • Fax: 215-427-4393
Mailing address:
  • Phone: 215-427-5470
  • Fax: 215-427-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD064264L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: