Healthcare Provider Details

I. General information

NPI: 1487572673
Provider Name (Legal Business Name): DURGAPRASAD KONDAPURAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UMASS BAYSTATE MEDICAL CENTER
SPRINGFIELD MA
01199-0001
US

IV. Provider business mailing address

188 DUSKY LN
SUFFIELD CT
06078-1954
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0000
  • Fax:
Mailing address:
  • Phone: 413-421-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3019721
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: