Provider Demographics
NPI:1477040616
Name:KANAKAMEDALA, AJAY CHAKRAVARTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:CHAKRAVARTHY
Last Name:KANAKAMEDALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4100 CASTALINA CT
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-2707
Mailing Address - Country:US
Mailing Address - Phone:412-607-5098
Mailing Address - Fax:
Practice Address - Street 1:181 W MEADOW DR STE 400
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5058
Practice Address - Country:US
Practice Address - Phone:970-476-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0069955207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery