Provider Demographics
NPI:1730281395
Name:KRISHNAN, BHANUMATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHANUMATHI
Middle Name:
Last Name:KRISHNAN
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 1:3023 HAMAKER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2222
Mailing Address - Country:US
Mailing Address - Phone:703-641-9161
Mailing Address - Fax:703-645-0493
Practice Address - Street 1:3023 HAMAKER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2222
Practice Address - Country:US
Practice Address - Phone:703-641-9161
Practice Address - Fax:703-645-0493
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266170207RC0000X
TXJ3524207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00V373C96OtherMEDICARE OF VA
280446OtherMAMSI
216678OtherANTHEM
216677OtherANTHEM HEALTHKEEPERS PLUS
280446OtherMDIPA
4417390OtherAETNA HMO
541977219OtherTRICARE
VA5844428Medicaid
280446OtherOPTIMUM CHOICE
4417390OtherAETNA PPO
0008OtherCAREFIRST
541977219OtherCIGNA
P00025883OtherRAILROAD MEDICARE
060059731OtherRAILROAD MEDICARE
280446OtherALLIANCE GEHA
541977219OtherNALC AFFORDABLE
541977219OtherUNITED HEALTHCARE
541977219OtherWPS TRICARE
0008OtherCAREFIRST
541977219OtherTRICARE