Provider Demographics
NPI:1891776746
Name:KRISHNA, VANDANA M (MD, MS, FAAAAI)
Entity type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:M
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:MD, MS, FAAAAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3904
Mailing Address - Country:US
Mailing Address - Phone:781-729-2293
Mailing Address - Fax:781-369-1493
Practice Address - Street 1:955 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-4302
Practice Address - Country:US
Practice Address - Phone:781-729-2293
Practice Address - Fax:781-369-1493
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203930207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25440OtherBCBS OF MA