Provider Demographics
NPI:1396749255
Name:RAMACHANDRAN, KRISH (MD)
Entity type:Individual
Prefix:DR
First Name:KRISH
Middle Name:
Last Name:RAMACHANDRAN
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 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:STE 300
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2465
Mailing Address - Country:US
Mailing Address - Phone:540-342-7941
Mailing Address - Fax:540-345-8423
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:STE 300
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-342-7941
Practice Address - Fax:540-345-8423
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052788174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5880947Medicaid
VA005877849Medicaid
VA060070647Medicare PIN
VA005877849Medicaid
VA5880947Medicaid
VAG47192Medicare UPIN