Provider Demographics
NPI:1578686242
Name:DONEPUDI, SREECHANDRA KANTH (MD)
Entity Type:Individual
Prefix:
First Name:SREECHANDRA
Middle Name:KANTH
Last Name:DONEPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:KANTH
Other - Last Name:DONEPUDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1490 BYERS ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-5831
Mailing Address - Country:US
Mailing Address - Phone:870-793-2207
Mailing Address - Fax:
Practice Address - Street 1:1490 BYERS ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-5831
Practice Address - Country:US
Practice Address - Phone:870-793-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE51042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H900Medicare PIN