Provider Demographics
NPI:1700975547
Name:KRISHNAN, LALITA (MD)
Entity Type:Individual
Prefix:DR
First Name:LALITA
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE STE 140
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6919
Mailing Address - Country:US
Mailing Address - Phone:865-483-7415
Mailing Address - Fax:
Practice Address - Street 1:988 OAK RIDGE TPKE STE 140
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6919
Practice Address - Country:US
Practice Address - Phone:865-483-7415
Practice Address - Fax:865-483-7980
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12298207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379961Medicaid
TNB03661Medicare UPIN
TN3379961Medicare ID - Type Unspecified