Provider Demographics
NPI:1568625408
Name:KRISHNAN, MAHESH (MD MPH FASN)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD MPH FASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 LANCIA DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2230
Mailing Address - Country:US
Mailing Address - Phone:703-821-1376
Mailing Address - Fax:
Practice Address - Street 1:1371 LANCIA DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2230
Practice Address - Country:US
Practice Address - Phone:703-821-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053953207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH12619Medicare UPIN