Healthcare Provider Details

I. General information

NPI: 1487845863
Provider Name (Legal Business Name): ASHA KRISHNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 ROSALIND AVENUE CARILION CLINIC
ROANOKE VA
24014
US

IV. Provider business mailing address

2118 ROSALIND AVENUE CARILION CLINIC
ROANOKE VA
24014
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7653
  • Fax:
Mailing address:
  • Phone: 540-981-7653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0116020077
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: