Provider Demographics
NPI:1134180466
Name:KRISHNAMURTHY, MAHESH (MD)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:
Last Name:KRISHNAMURTHY
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 708610
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8610
Mailing Address - Country:US
Mailing Address - Phone:800-846-5313
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:250 S 21ST ST
Practice Address - Street 2:#23
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3851
Practice Address - Country:US
Practice Address - Phone:610-250-4540
Practice Address - Fax:610-250-4774
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00252667OtherRAIL ROAD MEDICARE
PA2449108000OtherBCBS
PA101483129 0001Medicaid
MOP00252667OtherRAIL ROAD MEDICARE
PAI43853Medicare UPIN