Healthcare Provider Details

I. General information

NPI: 1124294061
Provider Name (Legal Business Name): ANASUYA KRISHNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD PEDIATRICS DEPT
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

1021 N GARFIELD ST APT #1020
ARLINGTON VA
22201-2548
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6652
  • Fax:
Mailing address:
  • Phone: 703-585-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116017730
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101244038
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: