Provider Demographics
NPI:1841226651
Name:KALAKUNTLA, RADHAKRISHNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHAKRISHNA
Middle Name:R
Last Name:KALAKUNTLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 TOWN CENTER DR STE 148
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1793
Mailing Address - Country:US
Mailing Address - Phone:215-702-7090
Mailing Address - Fax:215-702-7130
Practice Address - Street 1:825 TOWN CENTER DR STE 148
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1793
Practice Address - Country:US
Practice Address - Phone:215-702-7090
Practice Address - Fax:215-702-7130
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429241207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101653891Medicaid
PA1016538910002Medicaid
PA101653891Medicaid
PA1016538910002Medicaid