Provider Demographics
NPI:1982758132
Name:KONERU, CHANDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:S
Last Name:KONERU
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 1:1015 HIGHWAY 72 E
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611
Mailing Address - Country:US
Mailing Address - Phone:256-232-2505
Mailing Address - Fax:256-230-3226
Practice Address - Street 1:1015 HIGHWAY 72 E
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611
Practice Address - Country:US
Practice Address - Phone:256-232-2505
Practice Address - Fax:256-230-3226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110141195OtherRAILROAD MEDICARE
AL000034166Medicaid
AL000034166Medicare ID - Type Unspecified
AL000034166Medicaid