Provider Demographics
NPI:1295093466
Name:KOMANDURI, KRISHNA (DO)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:KOMANDURI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:609 W GERMANTOWN PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4251
Mailing Address - Country:US
Mailing Address - Phone:610-649-1175
Mailing Address - Fax:610-279-4841
Practice Address - Street 1:1591 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3224
Practice Address - Country:US
Practice Address - Phone:610-326-8005
Practice Address - Fax:610-705-3540
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018815207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology