Provider Demographics
NPI:1134446412
Name:DR KRISHNAMURTHY MEDICAL CENTER
Entity type:Organization
Organization Name:DR KRISHNAMURTHY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAMURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-306-1611
Mailing Address - Street 1:9470 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3025
Mailing Address - Country:US
Mailing Address - Phone:301-306-1611
Mailing Address - Fax:301-306-4567
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-306-1611
Practice Address - Fax:301-306-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB95104305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41644701OtherCARE 1ST
MDAS81010000001OtherCIGNA
05109OtherAMERICAID
MD854814OtherOPTIMUM CHOICE
MD4119-0001OtherBLUE CROSS BLUE SHIELD-BLUE CHOICE
MD90645OtherAETNA
001270446-002OtherUNITED HEALTHCARE
MD4119-0001OtherBLUE CROSS BLUE SHIELD-BLUE CHOICE