Healthcare Provider Details

I. General information

NPI: 1417484635
Provider Name (Legal Business Name): RATI PRIYA KRISHNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-6671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA10829200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD470655
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: