Provider Demographics
NPI:1316976566
Name:KRISHNA, KALPANA ANANTHA (MD)
Entity type:Individual
Prefix:DR
First Name:KALPANA
Middle Name:ANANTHA
Last Name:KRISHNA
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 1:1212 WALTER REED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4440
Mailing Address - Country:US
Mailing Address - Phone:910-488-6337
Mailing Address - Fax:910-488-1384
Practice Address - Street 1:1212 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4440
Practice Address - Country:US
Practice Address - Phone:910-488-6337
Practice Address - Fax:910-488-1384
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95000382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC50347OtherBLUE CROSS/BLUE SHIELD
NC8950347Medicaid
NC110148824OtherMEDICARE RAILROAD
F72909Medicare UPIN
NC2232496AMedicare PIN
NC110148824OtherMEDICARE RAILROAD
NC2232496AMedicare PIN