Provider Demographics
NPI:1457048084
Name:KHONDAKER, EVA PURNA (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:PURNA
Last Name:KHONDAKER
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 1:1319 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-3215
Mailing Address - Country:US
Mailing Address - Phone:402-552-3222
Mailing Address - Fax:
Practice Address - Street 1:1319 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-3215
Practice Address - Country:US
Practice Address - Phone:402-552-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-07-12
Deactivation Date:2023-11-27
Deactivation Code:
Reactivation Date:2024-01-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program