Individual
GEETHANJALI BANDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2310 ERWIN RD, DURHAM, NC 27710-3815
(919) 684-8111
Mailing address
3400 WAKE FOREST RD, RALEIGH, NC 27609-7317
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
052285
CT
207R00000X
Internal Medicine Physician
Primary
2013-01823
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336335108
—
IA
01
—
254338
MIDLANDS CHOICE
IA
01
—
70633
WELLMARK BLUE SHIELD
IA
01
—
CSP.0056619
CONTROLLED SUBSTANCE REGISTRATION
CT
Enumeration date
09/14/2007
Last updated
04/12/2024
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