Provider Demographics
NPI:1063778397
Name:ROHIT KHANOLKAR AND ASSOCIATES
Entity type:Organization
Organization Name:ROHIT KHANOLKAR AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:SURESH
Authorized Official - Last Name:KHANOLKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-773-8501
Mailing Address - Street 1:PO BOX 20726
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0726
Mailing Address - Country:US
Mailing Address - Phone:225-773-8501
Mailing Address - Fax:252-505-4272
Practice Address - Street 1:310 S MCCASKEY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2150
Practice Address - Country:US
Practice Address - Phone:225-773-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01344208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911164Medicaid
1720085681OtherINDIVIDUAL NPI
LA1469238Medicaid
124747Medicare UPIN
NC5911164Medicaid