Provider Demographics
NPI:1861500985
Name:KRISHNASWAMY, CHANDRASHEKAR (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRASHEKAR
Middle Name:
Last Name:KRISHNASWAMY
Suffix:
Gender:M
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:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0120
Mailing Address - Country:US
Mailing Address - Phone:606-487-7955
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3P
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9478
Practice Address - Country:US
Practice Address - Phone:606-487-7955
Practice Address - Fax:606-487-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY374302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000373082OtherANTHEM BLUE CROSS
KYDD8578OtherPALMETTO GBA GROUP
KY64054380Medicaid
KYP00256187OtherPALMETTO GBA INDIVIDUAL
KY64054380Medicaid
KYP00256187OtherPALMETTO GBA INDIVIDUAL
KY000000373082OtherANTHEM BLUE CROSS