Provider Demographics
NPI:1417480062
Name:KUNDURTI, NEEHAR R (MD)
Entity Type:Individual
Prefix:
First Name:NEEHAR
Middle Name:R
Last Name:KUNDURTI
Suffix:
Gender:M
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:MSC PEDIATRIC EMERGENCY MEDICINE
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-9432
Mailing Address - Fax:505-272-6503
Practice Address - Street 1:MSC PEDIATRIC EMERGENCY MEDICINE
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-9432
Practice Address - Fax:505-272-6503
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2020-0348390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program