Provider Demographics
NPI:1598778664
Name:KRISHNAGIRI, SARALA C (MD)
Entity Type:Individual
Prefix:
First Name:SARALA
Middle Name:C
Last Name:KRISHNAGIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2994 CHURCHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5643
Mailing Address - Country:US
Mailing Address - Phone:757-484-0500
Mailing Address - Fax:757-686-2805
Practice Address - Street 1:2994 CHURCHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5643
Practice Address - Country:US
Practice Address - Phone:757-484-0500
Practice Address - Fax:757-686-2805
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790612VOtherMEDICAID
110212340OtherMEDICARE RR
VA337677OtherBCBS
0402708OtherUNITED HEALTHCARE
2133070OtherALLIANCE OPTIMUM CHOICE
583517OtherTRAVELERS METRAHEALTH
VA005846676Medicaid
12621OtherOPTIMA
2133070OtherALLIANCE OPTIMUM CHOICE
VA005846676Medicaid