Active NPI
Shiv Simrun Khosla
- Geriatric Medicine (Internal Medicine) Physician
- Durham, NC
National Provider Identifier
1982916383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 190108
- Practice address
- 508 Fulton St
Durham VA Medical Center, Box 182
Durham, NC 27705-3875 - Phone
- (919) 286-0411
- NPI assigned
- Jul 14, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 245024 | MA | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 190108 | NC | Primary |
Addresses
Primary practice location
508 Fulton St
Durham VA Medical Center, Box 182
Durham, NC 27705-3875
Mailing address
508 Fulton St
Durham VA Medical Center, Box 182
Durham, NC 27705-3875
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 190108 | NC | MD | Geriatric Medicine (Internal Medicine) Physician |
| 245024 | MA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375056000000",
"number": "1982916383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508 FULTON ST",
"address_2": "DURHAM VA MEDICAL CENTER, BOX 182",
"city": "DURHAM",
"state": "NC",
"postal_code": "277053875"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 FULTON ST",
"address_2": "DURHAM VA MEDICAL CENTER, BOX 182",
"city": "DURHAM",
"state": "NC",
"postal_code": "277053875",
"telephone_number": "919-286-0411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSLA",
"first_name": "SHIV",
"middle_name": "SIMRUN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-14",
"last_updated": "2013-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "245024",
"primary": false
},
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NC",
"license": "190108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.