Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 282746 | NY |
N | 111NI0900X | Internist | 282746 | NY |
N | 207R00000X | Internist | MT196348 | PA |
N | 111NI0900X | Internist | MT196348 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 282746 | NY |
NPI | 1003120338 |
---|---|
Provider Name | Dr. Sreekanth Reddy Kondareddy |
First Address | Binghamton, NY 13905 |
Second Address | Vestal, NY 13850-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2010 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04501915 | (05) | NY |