Healthcare Provider Details

I. General information

NPI: 1235052960
Provider Name (Legal Business Name): RISEETHAN KIRISHNAVENTHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/10/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DRIVE
ABINGTON VA
24211
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DRIVE 4TH FLOOR, GME SUITE
ABINGTON VA
24211
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-4438
  • Fax: 276-258-4445
Mailing address:
  • Phone: 276-258-4438
  • Fax: 276-258-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: