Provider Demographics
NPI:1023210382
Name:TONDAPU, PRASANTHI (MD)
Entity Type:Individual
Prefix:
First Name:PRASANTHI
Middle Name:
Last Name:TONDAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 BRENDA DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-1001
Mailing Address - Country:US
Mailing Address - Phone:469-930-4655
Mailing Address - Fax:877-776-3240
Practice Address - Street 1:1141 KELLER PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1627
Practice Address - Country:US
Practice Address - Phone:469-930-4655
Practice Address - Fax:877-776-3240
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5547207R00000X, 390200000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112874604OtherMEDICAID GROUP TPI
TX213102101Medicaid
TX213102105OtherMEDICAID OTHER
TX213102106Medicaid
TXP01119012OtherRAILROAD MEDICARE
TX213102104Medicaid
TXP01119012OtherRAILROAD MEDICARE