Provider Demographics
NPI:1003915323
Name:KRISHNAMURTHY, VIBHA (MD)
Entity Type:Individual
Prefix:
First Name:VIBHA
Middle Name:
Last Name:KRISHNAMURTHY
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:C/O CONEVERY VALENCIUS
Mailing Address - Street 2:218 HARVARD ST
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170
Mailing Address - Country:US
Mailing Address - Phone:617-355-5010
Mailing Address - Fax:
Practice Address - Street 1:UMMEED CHILD DEV CENTER
Practice Address - Street 2:G-F, MANTRIPRIDE, B, 1/62
Practice Address - City:N.M. JOSHI MARY LOWE
Practice Address - State:IN
Practice Address - Zip Code:400005
Practice Address - Country:IN
Practice Address - Phone:617-355-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1543202080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities