Basic Information
| Provider Information | |||||||||
| NPI: | 1114926987 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHURMA | ||||||||
| FirstName: | SANTOSH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N PROGRESS DR | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453852666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375622280 | ||||||||
| FaxNumber: | 9375622282 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N. PROGRESS DR. | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373744041 | ||||||||
| FaxNumber: | 9373744020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 35046068 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 35046068 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00432943 | 01 | OH | RAILROAD MEDICARE | OTHER | 0687109 | 05 | OH | MEDICAID | 000000012488 | 01 | OH | ANTHEM | OTHER | 110089376 | 01 | OH | RAILROAD MEDICARE | OTHER |