Provider Demographics
NPI:1194040865
Name:DONDETI, RAJA SEKHAR REDDY (MD)
Entity Type:Individual
Prefix:
First Name:RAJA SEKHAR REDDY
Middle Name:
Last Name:DONDETI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJ
Other - Middle Name:
Other - Last Name:DONDETI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:701 SW REGIONAL AIRPORT BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72716-0001
Mailing Address - Country:US
Mailing Address - Phone:479-268-7640
Mailing Address - Fax:479-254-2951
Practice Address - Street 1:701 SW REGIONAL AIRPORT BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72716-0001
Practice Address - Country:US
Practice Address - Phone:479-268-7640
Practice Address - Fax:479-254-2951
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine