Provider Demographics
NPI:1780636969
Name:KRISHNA, RAJU PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJU
Middle Name:PRASAD
Last Name:KRISHNA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:222 PEMBROKE DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6201
Mailing Address - Country:US
Mailing Address - Phone:843-682-2345
Mailing Address - Fax:843-682-2343
Practice Address - Street 1:222 PEMBROKE DR
Practice Address - Street 2:BUILDING C
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6201
Practice Address - Country:US
Practice Address - Phone:843-682-2345
Practice Address - Fax:843-682-2343
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV282N0000X207L00000X
SC23153208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT73658Medicaid
SCH23338Medicare UPIN