Provider Demographics
NPI:1699955427
Name:DEONANAN, JOEL KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:KRISHNA
Last Name:DEONANAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-794-8624
Mailing Address - Fax:336-231-8845
Practice Address - Street 1:2827 LYNDHURST AVE STE 203
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4145
Practice Address - Country:US
Practice Address - Phone:336-794-8624
Practice Address - Fax:336-231-8845
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-017282086S0129X
NC390200000X208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917775Medicaid
VA1699955427Medicaid
NCNC1488AMedicare PIN