Individual
DR. JOEL KRISHNA DEONANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2827 LYNDHURST AVE STE 203, WINSTON SALEM, NC 27103-4145
(336) 794-8624
(336) 231-8845
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 794-8624
(336) 231-8845
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
390200000X
NC
2086S0129X
Vascular Surgery Physician
2009-01728
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699955427
—
VA
05
—
5917775
—
NC
Enumeration date
11/08/2007
Last updated
10/28/2020
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