Provider Demographics
NPI:1528624079
Name:KHANNA, RAASHI (DO)
Entity type:Individual
Prefix:
First Name:RAASHI
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 1:158 FELLA DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4436
Mailing Address - Country:US
Mailing Address - Phone:732-865-4298
Mailing Address - Fax:
Practice Address - Street 1:1025 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4223
Practice Address - Country:US
Practice Address - Phone:860-696-2400
Practice Address - Fax:860-696-2411
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA293298207R00000X
390200000X
CT74526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program