Provider Demographics
NPI:1700086626
Name:KONDA, KALPANA REDDY (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:REDDY
Last Name:KONDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KALPANA
Other - Middle Name:KESAVARAPU
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3030 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2574
Mailing Address - Country:US
Mailing Address - Phone:914-848-8630
Mailing Address - Fax:914-848-8631
Practice Address - Street 1:3030 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2574
Practice Address - Country:US
Practice Address - Phone:914-848-8630
Practice Address - Fax:914-848-8631
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250431207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1758Medicaid
NC5922735Medicaid
NCNCA572AMedicare PIN
NC5922735Medicaid