Provider Demographics
NPI:1457408932
Name:KRISHNAMURTHY, RAJASRI P (MD)
Entity type:Individual
Prefix:DR
First Name:RAJASRI
Middle Name:P
Last Name:KRISHNAMURTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-3131
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR STE 2G
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-434-3131
Practice Address - Fax:321-956-2541
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277483600Medicaid
FLAB134XOtherMEDICARE
FLME97696OtherMEDICAL LICENSE
FLPO1346567OtherRRMR
FLP00431570OtherRR MEDICARE