Provider Demographics
NPI:1720366222
Name:KONDA, PRAMEELA (MD,)
Entity Type:Individual
Prefix:
First Name:PRAMEELA
Middle Name:
Last Name:KONDA
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 1:23511 CHAGRIN BLVD
Mailing Address - Street 2:APT 319
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5528
Mailing Address - Country:US
Mailing Address - Phone:216-342-4794
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE, GENERAL SURGERY
Practice Address - Street 2:A100 CLEVELAND CLINIC,
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.019108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery