Basic Information
| Provider Information | |||||||||
| NPI: | 1275789430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGARSHETH | ||||||||
| FirstName: | KHANJAN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 S GREENE ST STE 10B100 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285840 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 419 W REDWOOD ST STE 240 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212017004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285840 | ||||||||
| FaxNumber: | 4103280717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 25MA09752900 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | 25MA09752900 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0129X | 25MA09752900 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD446266 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | D84537 | MD | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 103799788 | 05 | PA | MEDICAID |