Provider Demographics
NPI:1598739963
Name:CHUNDURI, RAMAMOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAMOHAN
Middle Name:
Last Name:CHUNDURI
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 1:7111 N MAIN ST
Mailing Address - Street 2:STE 10
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2558
Mailing Address - Country:US
Mailing Address - Phone:937-836-7130
Mailing Address - Fax:937-836-9727
Practice Address - Street 1:7111 N MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2558
Practice Address - Country:US
Practice Address - Phone:937-277-2121
Practice Address - Fax:937-277-2213
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH036281208D00000X
OH35.036821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249583Medicaid
A74888Medicare UPIN
OH0249583Medicaid