Healthcare Provider Details

I. General information

NPI: 1477717445
Provider Name (Legal Business Name): DR. RAMESH BABU KONDURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 DURANT RD STE 101
RALEIGH NC
27614-6566
US

IV. Provider business mailing address

203 MICHELANGELO WAY
CARY NC
27518-8716
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-0197
  • Fax: 919-870-0265
Mailing address:
  • Phone: 919-870-0197
  • Fax: 919-870-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number2010-00095
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2010-00095
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: