Provider Demographics
NPI:1720601289
Name:BANDARUPALLI, THARUN (MD)
Entity Type:Individual
Prefix:
First Name:THARUN
Middle Name:
Last Name:BANDARUPALLI
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 1:451 N PICKENS BRIDGE RD
Mailing Address - Street 2:APT 112
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686
Mailing Address - Country:US
Mailing Address - Phone:609-455-3973
Mailing Address - Fax:423-439-6386
Practice Address - Street 1:325 N STATE OF FRANKLIN ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6066
Practice Address - Country:US
Practice Address - Phone:423-439-6283
Practice Address - Fax:423-439-6386
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2023-04-20
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2023-04-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program