Provider Demographics
NPI:1982688396
Name:KRISHNAN, SETHU NMN (MD)
Entity Type:Individual
Prefix:DR
First Name:SETHU
Middle Name:NMN
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1818 RICHARDSON DR STE F
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5450
Mailing Address - Country:US
Mailing Address - Phone:336-342-4791
Mailing Address - Fax:336-634-0790
Practice Address - Street 1:1818 RICHARDSON DR STE F
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5450
Practice Address - Country:US
Practice Address - Phone:336-342-4791
Practice Address - Fax:336-634-0790
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31382208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340013002OtherRAILROAD MEDICARE
NC4289104002OtherCIGNA
NC890121CMedicaid
NC0121COtherBLUE CROSS BLUE SHIELD
NC4546OtherPARTNERS NATIONAL HEALTH
NC2381OtherPARTNERS MEDICARE
NC1901190OtherUNITED HEALTH CARE
NC5245349OtherAETNA
NC5245349OtherAETNA
NC890121CMedicaid
NC1901190OtherUNITED HEALTH CARE
NC5778940001Medicare NSC