Healthcare Provider Details

I. General information

NPI: 1548225139
Provider Name (Legal Business Name): CHANDRASEKHARAN KRISHNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST # 450
BOSTON MA
02111-1552
US

IV. Provider business mailing address

20 ROBINWOOD AVE APT #2
JAMAICA PLAIN MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-1183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number225169
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number225169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: