Healthcare Provider Details

I. General information

NPI: 1326039504
Provider Name (Legal Business Name): VIKRAM KRISHNASETTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N ELM ST STE 200
GREENSBORO NC
27401-6304
US

IV. Provider business mailing address

1331 N ELM ST SUITE 200
GREENSBORO NC
27401-6302
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-9617
  • Fax:
Mailing address:
  • Phone: 336-274-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35091059
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number220680
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: