MEDICARE: JAYASREE KHOSLA MD

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	207V00000X	Obstetrics & Gynecology Physician	25MA10370100	NJ
2	207V00000X	Obstetrics & Gynecology Physician	MD464847	PA

General Provider Information

NPI Number	:	1962821140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYASREE KHOSLA MD

Provider Business Mailing Address
First Line	:	1865 MARLTON PIKE EAST
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2013
Country	:	US
Telephone Number	:	856-427-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 MARLTON PIKE EAST
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2013
Country	:	US
Telephone Number	:	856-427-4336
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	09/12/2022

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