Provider Demographics
NPI:1285900928
Name:KHANNA, ROOHI (DO)
Entity type:Individual
Prefix:
First Name:ROOHI
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2310
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:
Practice Address - Street 1:6 BRIGHTON RD FL 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1647
Practice Address - Country:US
Practice Address - Phone:973-777-7911
Practice Address - Fax:973-777-5403
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264759207Q00000X
NJ25MB10151600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine