Provider Demographics
NPI:1851364020
Name:KRISHNASAMY, ANITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITHA
Middle Name:
Last Name:KRISHNASAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANITHA
Other - Middle Name:
Other - Last Name:SRINIVASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 COVE WAY
Mailing Address - Street 2:UNIT # 104
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5886
Mailing Address - Country:US
Mailing Address - Phone:617-773-8493
Mailing Address - Fax:617-773-8493
Practice Address - Street 1:509 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-7189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01886207R00000X, 208M00000X
MA218725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine