Individual
PRASANNA VENKATESH KRISHNASAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., MPH
Contact information
Practice address
2800 N VANCOUVER AVE, SUITE 230 (LEGACY MEDICAL GROUP - EMANUEL), PORTLAND, OR 97227-1630
(503) 413-4340
(503) 413-4898
Mailing address
2800 N VANCOUVER AVE, SUITE 230 (LEGACY MEDICAL GROUP - EMANUEL), PORTLAND, OR 97227-1630
(503) 413-4340
(503) 413-4898
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD125896
OR
Other
Enumeration date
07/15/2007
Last updated
10/31/2011
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