Healthcare Provider Details

I. General information

NPI: 1174526925
Provider Name (Legal Business Name): AKULA V KRISHNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

1201 NOTT ST STE 306
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

1201 NOTT ST STE 306
SCHENECTADY NY
12308-2589
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-6950
  • Fax: 518-377-9258
Mailing address:
  • Phone: 518-377-6950
  • Fax: 518-377-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number121593
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: