Basic Information
| Provider Information | |||||||||
| NPI: | 1477644003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHERA | ||||||||
| FirstName: | SAMIRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 HURLEY AVENUE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124013738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453388680 | ||||||||
| FaxNumber: | 8453388693 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 HURLEY AVENUE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124013738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453388680 | ||||||||
| FaxNumber: | 8453388693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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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 | 208600000X | 35716 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | 250995 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208600000X | 250995 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | FK0542616 | 01 | NY | DEA NY | OTHER | 03079458 | 05 | NY | MEDICAID |