Provider Demographics
NPI:1477789840
Name:KONDA, SUMITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMITRA
Middle Name:
Last Name:KONDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 MARKET STREET
Mailing Address - Street 2:SUITE 560W UPHS-OFFICE OF MEDICAL AFFAIRS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2617
Mailing Address - Country:US
Mailing Address - Phone:215-662-3958
Mailing Address - Fax:
Practice Address - Street 1:824 MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-935-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188166207R00000X
PAMD437972207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine