Provider Demographics
NPI:1477717445
Name:KONDURU, RAMESH BABU
Entity type:Individual
Prefix:DR
First Name:RAMESH
Middle Name:BABU
Last Name:KONDURU
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 1:203 MICHELANGELO WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8716
Mailing Address - Country:US
Mailing Address - Phone:919-870-0197
Mailing Address - Fax:919-870-0265
Practice Address - Street 1:10640 DURANT RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6566
Practice Address - Country:US
Practice Address - Phone:919-870-0197
Practice Address - Fax:919-870-0265
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00095207RG0300X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919360Medicaid
NC5919360Medicaid
NCNC3540AMedicare PIN