Provider Demographics
NPI:1659396679
Name:KRISHNAMURTHY, LEELA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LEELA
Middle Name:
Last Name:KRISHNAMURTHY
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 1:9470 ANNAPOLIS ROAD
Mailing Address - Street 2:#301
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3076
Mailing Address - Country:US
Mailing Address - Phone:301-306-1611
Mailing Address - Fax:301-306-4567
Practice Address - Street 1:9470 ANNAPOLIS ROAD
Practice Address - Street 2:#301
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3076
Practice Address - Country:US
Practice Address - Phone:301-306-1611
Practice Address - Fax:301-306-4567
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B95104Medicare UPIN
478166K20Medicare ID - Type Unspecified