Provider Demographics
NPI:1629219407
Name:SIRIKONDA, PURNACHANDER RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNACHANDER
Middle Name:RAO
Last Name:SIRIKONDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 S COLLINS ST STE 141
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1159
Mailing Address - Country:US
Mailing Address - Phone:817-417-9001
Mailing Address - Fax:817-417-9008
Practice Address - Street 1:4907 S COLLINS ST STE 141
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1159
Practice Address - Country:US
Practice Address - Phone:817-417-9001
Practice Address - Fax:817-417-9008
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3918591Medicaid