Provider Demographics
NPI:1841360930
Name:CHUNDURU, NAGESWARA RAO (MD)
Entity type:Individual
Prefix:DR
First Name:NAGESWARA
Middle Name:RAO
Last Name:CHUNDURU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3012
Mailing Address - Country:US
Mailing Address - Phone:615-867-3780
Mailing Address - Fax:615-867-3786
Practice Address - Street 1:528 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3012
Practice Address - Country:US
Practice Address - Phone:615-867-3780
Practice Address - Fax:615-867-3786
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719365Medicaid
TN3800862Medicare ID - Type Unspecified
TN3719365Medicaid