Provider Demographics
NPI:1841636305
Name:VANAM, KRISHNA (DO)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:VANAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12342 SMITH GROVE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7176
Mailing Address - Country:US
Mailing Address - Phone:908-279-5086
Mailing Address - Fax:
Practice Address - Street 1:5700 FITZHUGH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1800
Practice Address - Country:US
Practice Address - Phone:908-279-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206643207R00000X
NC2016-00898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine