Individual
MR. ANANTHAN KRISHNATHAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4605 MACCORKLE AVE. SW, SOUTH CHARLESTON, WV 25309
(304) 766-3526
Mailing address
4605 MACCORKLE AVE. SW, SOUTH CHARLESTON, WV 25309
(304) 766-3526
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21702
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000987
—
WV
Enumeration date
11/02/2005
Last updated
09/07/2012
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