Provider Demographics
NPI:1720095458
Name:NAYAK, KRISHEN KESAV (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHEN
Middle Name:KESAV
Last Name:NAYAK
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 1:214 COLLEGE PARK PLAZA
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2833
Mailing Address - Country:US
Mailing Address - Phone:814-262-0025
Mailing Address - Fax:814-266-8745
Practice Address - Street 1:4501 ADMIRAL PEARY HIGHWAY
Practice Address - Street 2:EBENSBURG CENTER
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-0600
Practice Address - Country:US
Practice Address - Phone:814-472-0226
Practice Address - Fax:814-472-8624
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042800E2084P0800X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39785Medicare UPIN
133968Medicare PIN
P00432634Medicare PIN