Provider Demographics
NPI:1255310165
Name:KISHORE, ANAND T (MD)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:T
Last Name:KISHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-731-3222
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:SUITE 320
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-3222
Practice Address - Fax:540-731-3060
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA100002374207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010269865Medicaid
VA010269857Medicaid
VA010269881Medicaid
VA018042C18Medicare PIN
VA010269881Medicaid
VA010269857Medicaid
VA010746C40Medicare PIN