Healthcare Provider Details

I. General information

NPI: 1902857683
Provider Name (Legal Business Name): KRISHNA SANKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INTERSTATE DRIVE
COVINGTON VA
24426
US

IV. Provider business mailing address

201 INTERSTATE DRIVE
COVINGTON VA
24426
US

V. Phone/Fax

Practice location:
  • Phone: 540-962-4621
  • Fax: 540-962-7573
Mailing address:
  • Phone: 540-962-4621
  • Fax: 540-962-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101022731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: