Provider Demographics
NPI:1932398534
Name:R CHUNDURI MD INC
Entity Type:Organization
Organization Name:R CHUNDURI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAMOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNDURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-836-7130
Mailing Address - Street 1:1230 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2552
Mailing Address - Country:US
Mailing Address - Phone:937-836-7130
Mailing Address - Fax:937-836-9727
Practice Address - Street 1:1230 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2552
Practice Address - Country:US
Practice Address - Phone:937-836-7130
Practice Address - Fax:937-836-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0249583Medicaid
9199211Medicare PIN
A 74888Medicare UPIN