Provider Demographics
NPI:1265643563
Name:GANDRA, SUSHMITHA (MD)
Entity Type:Individual
Prefix:
First Name:SUSHMITHA
Middle Name:
Last Name:GANDRA
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 1:240 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1832
Mailing Address - Country:US
Mailing Address - Phone:215-757-5772
Mailing Address - Fax:215-757-5494
Practice Address - Street 1:240 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1832
Practice Address - Country:US
Practice Address - Phone:215-757-5772
Practice Address - Fax:215-757-5494
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD433932207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology