Provider Demographics
NPI:1912107483
Name:NAGESWARA RAO CHUNDURU
Entity Type:Organization
Organization Name:NAGESWARA RAO CHUNDURU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGESWARA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:CHUNDURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-867-3780
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800862Medicare PIN