MEDICARE: CHANDANA KONDURU M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	D0070397	MD
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	Q0778	TX

General Provider Information

NPI Number	:	1669423281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDANA KONDURU M.D.

Provider Business Mailing Address
First Line	:	3602 MATLOCK RD STE 202
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3600
Country	:	US
Telephone Number	:	682-302-0430
Fax Number	:	682-302-0430

Provider Business Practice Location Address
First Line	:	3602 MATLOCK RD STE 202
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3600
Country	:	US
Telephone Number	:	972-647-8404
Fax Number	:	972-641-8398

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	04/10/2020

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