Healthcare Provider Details

I. General information

NPI: 1023202611
Provider Name (Legal Business Name): VINAY VARDHAN REDDY KANDULA MBBS,FRCR, MRCP, DCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ROCKLAND RD DEPARTMENT OF RADIOLOGY, A.I DUPONT CHILDREN'S HOSPITAL
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

3964 GATEWAY DR APARTMENT A1
PHILADELPHIA PA
19145-6002
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4664
  • Fax: 302-651-4476
Mailing address:
  • Phone: 302-252-8288
  • Fax: 302-651-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC7-0003672
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD433905
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberC1-0008916
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMT192173
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: