Provider Demographics
NPI:1407608789
Name:KONDAVERTI, RAHUL (MBBS)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:KONDAVERTI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MAIN ST, 2ND FLOOR,
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-829-5060
Mailing Address - Fax:716-829-5051
Practice Address - Street 1:1010 MAIN ST, 2ND FLOOR,
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-829-5060
Practice Address - Fax:716-829-5051
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program