Provider Demographics
NPI:1639631260
Name:KONERU, CHAITANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:
Last Name:KONERU
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 1:6624 FANNIN ST STE 1240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2324
Mailing Address - Country:US
Mailing Address - Phone:832-355-5575
Mailing Address - Fax:
Practice Address - Street 1:6624 FANNIN ST STE 1240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2324
Practice Address - Country:US
Practice Address - Phone:832-355-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47279207Q00000X
TX47896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine