Provider Demographics
NPI:1356397400
Name:KRISHNAIAH, MAHESH K (MD)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:K
Last Name:KRISHNAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2080 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7359
Mailing Address - Country:US
Mailing Address - Phone:718-250-6915
Mailing Address - Fax:718-250-6489
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-250-6915
Practice Address - Fax:718-250-6489
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2021-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY222326207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02277934Medicaid
NY45C891Medicare PIN
NY02277934Medicaid