Basic Information
| Provider Information | |||||||||
| NPI: | 1093768897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHOSLA | ||||||||
| FirstName: | SUBHASH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404411934 | ||||||||
| FaxNumber: | 7404465982 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404465129 | ||||||||
| FaxNumber: | 7404465622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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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 | 2085R0001X | 35-05-3207 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 14983 | WV | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000007230 | 01 | ANTHEM BCBS | OTHER | P00900234 | 01 | KY | MEDICARE RAILROAD | OTHER | 0625685 | 01 | OH | MOLINA MEDICAID | OTHER | 0625685 | 05 | OH | MEDICAID | 310971085162 | 01 | OH | CARESOURCE MEDICAID | OTHER | 001714041 | 01 | MOUNTAIN STATE BCBS | OTHER | 0124046000 | 05 | WV | MEDICAID | 000000185263 | 01 | OH | UNISON MEDICAID | OTHER | 920000406 | 01 | RR MEDICARE | OTHER |