Basic Information
| Provider Information | |||||||||
| NPI: | 1467502401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHUNTIA | ||||||||
| FirstName: | ANJANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 SENTRY PKWY E | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194222324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108255800 | ||||||||
| FaxNumber: | 6103970980 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 SENTRY PKWY E | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194222324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108255800 | ||||||||
| FaxNumber: | 6103970980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0201X | 036114217 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | 207K00000X | MD435625 | PA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 036114217 | 05 | IL | MEDICAID |