Provider Demographics
NPI:1619071065
Name:BHAGHAYATH, KRISHNA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:REDDY
Last Name:BHAGHAYATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 CHARLES ROLLINS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2882
Mailing Address - Country:US
Mailing Address - Phone:252-436-6240
Mailing Address - Fax:252-492-5707
Practice Address - Street 1:120 CHARLES ROLLINS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2882
Practice Address - Country:US
Practice Address - Phone:252-436-6240
Practice Address - Fax:252-492-5707
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH12642207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078651Medicaid
NH30205244Medicaid
NHRE8343Medicare ID - Type Unspecified
NHT400136017Medicare PIN
NHI 35744Medicare UPIN