Provider Demographics
NPI:1730100413
Name:DESHPANDE, KRISHNA B (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:B
Last Name:DESHPANDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 BRADENTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3551
Mailing Address - Country:US
Mailing Address - Phone:937-707-4662
Mailing Address - Fax:614-573-0530
Practice Address - Street 1:4995 BRADENTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3551
Practice Address - Country:US
Practice Address - Phone:937-707-4662
Practice Address - Fax:614-573-0530
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-041372208600000X
OH35041372208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0363753Medicaid