Provider Demographics
NPI:1366402026
Name:KRISHNAN, RADHA K (MD)
Entity type:Individual
Prefix:DR
First Name:RADHA
Middle Name:K
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RADHA
Other - Middle Name:K
Other - Last Name:KRISHNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PC
Mailing Address - Street 1:615 FREDERICK ST
Mailing Address - Street 2:PO BOX 1676
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1676
Mailing Address - Country:US
Mailing Address - Phone:304-325-5468
Mailing Address - Fax:
Practice Address - Street 1:615 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-1676
Practice Address - Country:US
Practice Address - Phone:304-325-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10346207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV111029882OtherMEDICARE RAILROAD
WV111029882OtherMEDICARE RAILROAD