Provider Demographics
NPI:1912169459
Name:KALLUMADANDA, VINNIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:VINNIE
Middle Name:D
Last Name:KALLUMADANDA
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 1:2507 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8463
Mailing Address - Country:US
Mailing Address - Phone:956-688-8181
Mailing Address - Fax:956-688-8034
Practice Address - Street 1:2507 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8463
Practice Address - Country:US
Practice Address - Phone:956-688-8181
Practice Address - Fax:956-688-8034
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L18488Medicare PIN