Provider Demographics
NPI:1336405364
Name:KHAJA, SARA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KHAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7423 S MASON-MONTGOMERY ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7828
Mailing Address - Country:US
Mailing Address - Phone:513-398-3445
Mailing Address - Fax:513-398-4680
Practice Address - Street 1:7423 S MASON-MONTGOMERY ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7828
Practice Address - Country:US
Practice Address - Phone:513-398-3445
Practice Address - Fax:513-398-4680
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.125694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11231984OtherDOB
OHH459820Medicare PIN