MEDICARE: DR. PRIYAMVADA KHANDHERIA M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0015X	Psychosomatic Medicine Physician	G4325	TX

General Provider Information

NPI Number	:	1275749178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYAMVADA KHANDHERIA M.D

Provider Business Mailing Address
First Line	:	2424 50TH ST
Second Line	:	SUITE 301
City	:	LUBBOCK
State	:	TX
Zip	:	79412-2549
Country	:	US
Telephone Number	:	806-795-2533
Fax Number	:	806-795-0336

Provider Business Practice Location Address
First Line	:	2424 50TH ST
Second Line	:	SUITE 301
City	:	LUBBOCK
State	:	TX
Zip	:	79412-2549
Country	:	US
Telephone Number	:	806-795-2533
Fax Number	:	806-795-0336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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