Provider Demographics
NPI:1174589063
Name:KRISHNAMURTHY, SARADA (MD)
Entity type:Individual
Prefix:DR
First Name:SARADA
Middle Name:
Last Name:KRISHNAMURTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3451
Mailing Address - Country:US
Mailing Address - Phone:716-674-3104
Mailing Address - Fax:859-257-7715
Practice Address - Street 1:3612 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3451
Practice Address - Country:US
Practice Address - Phone:716-674-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47171207R00000X, 207RH0003X
NC2017-02011207RH0003X
FLME114275207RH0003X
NY226869207RH0003X
NC201702011207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02648039Medicaid
NY6Z2431Medicare ID - Type Unspecified
I30850Medicare UPIN