Provider Demographics
NPI:1669423281
Name:KONDURU, CHANDANA (MD)
Entity type:Individual
Prefix:
First Name:CHANDANA
Middle Name:
Last Name:KONDURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 MATLOCK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3600
Mailing Address - Country:US
Mailing Address - Phone:682-302-0430
Mailing Address - Fax:682-302-0430
Practice Address - Street 1:3602 MATLOCK RD STE 202
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3600
Practice Address - Country:US
Practice Address - Phone:972-647-8404
Practice Address - Fax:972-641-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070397207RE0101X
TXQ0778207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457938YKPWMedicare PIN
DC189427ZAGGMedicare PIN