Provider Demographics
NPI:1457301269
Name:KRISHNAN, GOKUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GOKUL
Middle Name:
Last Name:KRISHNAN
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 1:618 S MAIN ST
Mailing Address - Street 2:INCOMPASS HEALTH
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5020
Mailing Address - Country:US
Mailing Address - Phone:336-951-4878
Mailing Address - Fax:336-951-4566
Practice Address - Street 1:618 S MAIN ST
Practice Address - Street 2:INCOMPASS HEALTH
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5020
Practice Address - Country:US
Practice Address - Phone:336-951-4878
Practice Address - Fax:336-951-4566
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC213254OtherMEDCOST
NC5902854Medicaid
NC74533359OtherAETNA
NC213254OtherMEDCOST
NC5902854Medicaid