Provider Demographics
NPI:1487702718
Name:A & S KHANDELWAL MD INC
Entity type:Organization
Organization Name:A & S KHANDELWAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:V
Authorized Official - Last Name:KHANDELWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-723-7999
Mailing Address - Street 1:970 E WASHINGTON ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2181
Mailing Address - Country:US
Mailing Address - Phone:330-723-7999
Mailing Address - Fax:330-764-9907
Practice Address - Street 1:970 E WASHINGTON ST STE 2F
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2181
Practice Address - Country:US
Practice Address - Phone:330-723-7999
Practice Address - Fax:330-764-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH051224K207RP1001X
OH35-054767K207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0880702Medicaid
OH0880702Medicaid