Provider Demographics
NPI:1598962623
Name:BONDALAPATI, PRAVEEN KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:KUMAR
Last Name:BONDALAPATI
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 1:161 RIVERSIDE DR
Mailing Address - Street 2:SUITE M05
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4176
Mailing Address - Country:US
Mailing Address - Phone:607-798-5442
Mailing Address - Fax:
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE M05
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-798-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273844207RP1001X
PAMD439408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1598962Medicaid
RI1598962Medicaid