Provider Demographics
NPI:1154637353
Name:KOTHAGUNDLA, CHANDRASEKHAR (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRASEKHAR
Middle Name:
Last Name:KOTHAGUNDLA
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-3789
Mailing Address - Fax:704-316-6785
Practice Address - Street 1:10030 GILEAD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-316-3789
Practice Address - Fax:704-316-6785
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-03349208M00000X
NE27509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine