Provider Demographics
NPI:1275579542
Name:KRISHNA, ARVIND Y (MD)
Entity Type:Individual
Prefix:
First Name:ARVIND
Middle Name:Y
Last Name:KRISHNA
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 1:4565 DRESSLER RD NW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2549
Mailing Address - Country:US
Mailing Address - Phone:330-493-0013
Mailing Address - Fax:330-493-6973
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:SUITE 111
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2549
Practice Address - Country:US
Practice Address - Phone:330-493-0013
Practice Address - Fax:330-493-6973
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068403K207RE0101X
GA036553207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168161Medicaid
OH0168161Medicaid
G16709Medicare UPIN