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General NPI Number Information
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NPI Number | 1144221904
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Entity Type | Individual
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Provider Name | RAVI C. KHANNA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 148 W NORTH ST
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2547
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Country | US
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Telephone | 937-323-5001
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Fax | 937-323-5413
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Provider Business Mailing Address
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Address Line | 148 W NORTH ST
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2547
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Country | US
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Telephone | 937-323-5001
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Fax | 937-323-5413
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 35040509K
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License Number State | OH
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