Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M5547 | TX |
N | 111NI0900X | Internist | M5547 | TX |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | M5547 | TX |
NPI | 1023210382 |
---|---|
Provider Name | Prasanthi Tondapu |
First Address | Flower Mound, TX 75022-1001 |
Second Address | Keller, TX 76248-1627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 22/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112874604 | MEDICAID GROUP TPI (01) | TX |
213102101 | (05) | TX |
213102104 | (05) | TX |
213102105 | MEDICAID OTHER (01) | TX |
213102106 | (05) | TX |
P01119012 | RAILROAD MEDICARE (01) | TX |