Healthcare Provider Details

I. General information

NPI: 1952930869
Provider Name (Legal Business Name): KRISHNA HEGDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/26/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

IV. Provider business mailing address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5414
  • Fax:
Mailing address:
  • Phone: 614-566-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number322812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: