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General NPI Number Information
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NPI Number | 1346686185
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Entity Type | Organization
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Legal Business Name | VIJAY KONDA MD PA
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 3447 PINE RIDGE RD SUITE 101
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City | NAPLES
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State | FL
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Zip | 34109-3927
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Country | US
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Telephone | 904-207-2560
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 IMMOKALEE RD SUITE 183
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City | NAPLES
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State | FL
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Zip | 34110-1445
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Country | US
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Telephone | 904-207-2560
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIJAY K KONDA
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Credential | M.D.
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Telephone | 904-207-2560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME96103
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License Number State | FL
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