1053500074 NPI number — RUKMINI MADHURI KONATALAPALLI M.D

Table of content: RUKMINI MADHURI KONATALAPALLI M.D (NPI 1053500074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053500074 NPI number — RUKMINI MADHURI KONATALAPALLI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONATALAPALLI
Provider First Name:
RUKMINI
Provider Middle Name:
MADHURI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BHANDARU
Provider Other First Name:
RUKMINI
Provider Other Middle Name:
MADHURI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053500074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7300 HANOVER DRIVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-345-5600
Provider Business Mailing Address Fax Number:
301-345-7715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 HANOVER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-345-5600
Provider Business Practice Location Address Fax Number:
301-345-7715
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  D0066339 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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