Healthcare Provider Details

I. General information

NPI: 1235826611
Provider Name (Legal Business Name): SANGEETHA KRISHNAMOORTHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KEMPSVILLE RD STE 200A
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

850 KEMPSVILLE RD STE 200A
NORFOLK VA
23502-3920
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-5910
  • Fax: 757-466-0321
Mailing address:
  • Phone: 757-261-5910
  • Fax: 757-466-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101288337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: