Provider Demographics
NPI:1326007659
Name:RONDLA, SUCHITRA (MBBS)
Entity Type:Individual
Prefix:
First Name:SUCHITRA
Middle Name:
Last Name:RONDLA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 LEXINGTON AVENUE NORTH
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8056
Mailing Address - Country:US
Mailing Address - Phone:651-251-5280
Mailing Address - Fax:651-251-5282
Practice Address - Street 1:3585 LEXINGTON AVENUE NORTH
Practice Address - Street 2:SUITE 350
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8056
Practice Address - Country:US
Practice Address - Phone:651-494-3942
Practice Address - Fax:651-787-0519
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48207208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN395421800Medicaid
370003086Medicare ID - Type Unspecified
MN395421800Medicaid
H45979Medicare UPIN