Healthcare Provider Details

I. General information

NPI: 1609512276
Provider Name (Legal Business Name): VISHAL KRISHNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 ST LUKES BLVD
EASTON PA
18045-5669
US

IV. Provider business mailing address

1700 ST LUKES BLVD
EASTON PA
18045-5670
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1000
  • Fax: 717-851-3559
Mailing address:
  • Phone: 484-526-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT225926
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT225926
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: