Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | TRN# 13766 | FL |
N | 111NI0900X | Internist | TRN# 13766 | FL |
Y | 207RX0202X | Medical Oncology | 35126311 | OH |
NPI | 1063642148 |
---|---|
Provider Name | Bhavana Konda |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43221-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0132217 | (05) | OH |