1730281395 NPI number — DR. BHANUMATHI KRISHNAN MD

Table of content: DR. BHANUMATHI KRISHNAN MD (NPI 1730281395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730281395 NPI number — DR. BHANUMATHI KRISHNAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISHNAN
Provider First Name:
BHANUMATHI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730281395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3023 HAMAKER CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-641-9161
Provider Business Mailing Address Fax Number:
703-645-0493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3023 HAMAKER CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-641-9161
Provider Business Practice Location Address Fax Number:
703-645-0493
Provider Enumeration Date:
09/03/2006

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: 207RC0000X , with the licence number:  0101266170 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: J3524 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00V373C96 . This is a "MEDICARE OF VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280446 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 216678 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 216677 . This is a "ANTHEM HEALTHKEEPERS PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280446 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4417390 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5844428 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280446 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4417390 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00025883 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060059731 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280446 . This is a "ALLIANCE GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "NALC AFFORDABLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541977219 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".




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