Provider Demographics
NPI:1093076671
Name:PONNADA, VARA VENKATA PADMA KAMALA KUMARI (MD)
Entity Type:Individual
Prefix:
First Name:VARA VENKATA PADMA
Middle Name:KAMALA KUMARI
Last Name:PONNADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VARA VENKATA
Other - Middle Name:
Other - Last Name:PONNADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:146 W DALE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-235-3838
Mailing Address - Fax:319-235-5078
Practice Address - Street 1:146 W DALE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1901
Practice Address - Country:US
Practice Address - Phone:319-235-3838
Practice Address - Fax:319-235-5078
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39962207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine