Provider Demographics
NPI:1114114790
Name:ASHOK V. KONDRU, MD INC
Entity Type:Organization
Organization Name:ASHOK V. KONDRU, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:V
Authorized Official - Last Name:KONDRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-998-0322
Mailing Address - Street 1:2112 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3436
Mailing Address - Country:US
Mailing Address - Phone:440-998-0322
Mailing Address - Fax:440-998-4525
Practice Address - Street 1:2112 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3436
Practice Address - Country:US
Practice Address - Phone:440-998-0322
Practice Address - Fax:440-998-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35063118207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9370811Medicare PIN