Healthcare Provider Details

I. General information

NPI: 1043305717
Provider Name (Legal Business Name): KRISHNA SANKAR M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INTERSTATE DR
COVINGTON VA
24426-6441
US

IV. Provider business mailing address

201 INTERSTATE DR
COVINGTON VA
24426-6441
US

V. Phone/Fax

Practice location:
  • Phone: 540-962-4710
  • Fax: 540-962-7573
Mailing address:
  • Phone: 540-962-4710
  • Fax: 540-962-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberP063015
License Number StateVA

VIII. Authorized Official

Name: DR. KRISHNA SANKAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 540-962-4710