Individual
PRADEEP K. KANDULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5371
(740) 446-5711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
19937
WV
208000000X
Pediatrics Physician
Primary
35.073733
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006496
ANTHEM BCBS
—
01
—
000000181956
UNISON MEDICAID
OH
01
—
001714099
MOUNTAIN STATE BCBS
—
05
—
0111254000
—
WV
01
—
2048108
MOLINA MEDICAID
OH
05
—
2048108
—
OH
01
—
310917085048
CARESOURCE MEDICAID
OH
01
—
370009999
RR MEDICARE
—
Enumeration date
05/20/2006
Last updated
01/21/2021
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