Provider Demographics
NPI:1265443097
Name:KRISHNARAJ, MUTHAIYA PILLAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUTHAIYA
Middle Name:PILLAI
Last Name:KRISHNARAJ
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 1:2611 PINENEEDLES RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4242
Mailing Address - Country:US
Mailing Address - Phone:919-736-3603
Mailing Address - Fax:
Practice Address - Street 1:201 STEVENS MILL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1056
Practice Address - Country:US
Practice Address - Phone:919-731-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC237252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950345Medicaid
NC208001EOtherMEDICARE PROVIDER NUMBER
NC208001EOtherMEDICARE PROVIDER NUMBER