Provider Demographics
NPI:1376867788
Name:KONDISETTI, VENKATA SIVA MANJARI (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:SIVA MANJARI
Last Name:KONDISETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VENKATA
Other - Middle Name:SIVA MANJARI
Other - Last Name:GARIKAPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:320 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1900
Mailing Address - Country:US
Mailing Address - Phone:276-666-7394
Mailing Address - Fax:276-666-7866
Practice Address - Street 1:320 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1900
Practice Address - Country:US
Practice Address - Phone:276-666-7394
Practice Address - Fax:276-666-7866
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007016899207R00000X, 208M00000X
KY44008208M00000X
VA0101276171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist