Provider Demographics
NPI:1023202611
Name:KANDULA, VINAY VARDHAN REDDY (MBBS,FRCR, MRCP, DCH)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:VARDHAN REDDY
Last Name:KANDULA
Suffix:
Gender:M
Credentials:MBBS,FRCR, MRCP, DCH
Other - Prefix:
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Mailing Address - Street 1:3964 GATEWAY DR
Mailing Address - Street 2:APARTMENT A1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-6002
Mailing Address - Country:US
Mailing Address - Phone:302-252-8288
Mailing Address - Fax:302-651-4476
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY, A.I DUPONT CHILDREN'S HOSPITAL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4664
Practice Address - Fax:302-651-4476
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC7-00036722085P0229X
PAMD4339052085P0229X
DEC1-00089162085P0229X
PAMT1921732085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology