Basic Information
| Provider Information | |||||||||
| NPI: | 1851364020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRISHNASAMY | ||||||||
| FirstName: | ANITHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SRINIVASAN | ||||||||
| OtherFirstName: | ANITHA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 COVE WAY | ||||||||
| Address2: | UNIT # 104 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021695886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177738493 | ||||||||
| FaxNumber: | 6177738493 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 N BRIGHTLEAF BLVD | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199387189 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2021-01886 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 218725 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2021-01886 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.