Provider Demographics
NPI:1821354176
Name:KONDABOLU, SIRISH KUMAR
Entity Type:Individual
Prefix:
First Name:SIRISH
Middle Name:KUMAR
Last Name:KONDABOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:912 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-7971
Practice Address - Fax:717-272-1241
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275452207X00000X
PAMD465257207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery