1265480685 NPI number — DR. RUTH NISHA KRISHNAN M.D.

Table of content: DR. RUTH NISHA KRISHNAN M.D. (NPI 1265480685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265480685 NPI number — DR. RUTH NISHA KRISHNAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISHNAN
Provider First Name:
RUTH
Provider Middle Name:
NISHA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUNDARA
Provider Other First Name:
RUTH
Provider Other Middle Name:
NISHA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265480685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 WORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246-1608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-828-1745
Provider Business Mailing Address Fax Number:
214-828-1734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 WORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-828-1745
Provider Business Practice Location Address Fax Number:
214-828-1734
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD0000039396 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N6438 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 216944301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8CL572 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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