Healthcare Provider Details

I. General information

NPI: 1063561090
Provider Name (Legal Business Name): ANITA KRISHNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW 3RD FLOOR, WEST WING
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

3711 39TH ST NW C-189
WASHINGTON DC
20016-5518
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-5701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD034955
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: