MEDICARE: DR. RAMAMOHAN CHUNDURI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036281	OH
2	207R00000X	Internal Medicine Physician	35.036821	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598739963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMAMOHAN CHUNDURI MD

Provider Business Mailing Address
First Line	:	7111 N MAIN ST
Second Line	:	STE 10
City	:	DAYTON
State	:	OH
Zip	:	45415-2558
Country	:	US
Telephone Number	:	937-836-7130
Fax Number	:	937-836-9727

Provider Business Practice Location Address
First Line	:	7111 N MAIN ST STE 10
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2558
Country	:	US
Telephone Number	:	937-277-2121
Fax Number	:	937-277-2213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	01/09/2020

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