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Individual

JAISHEELA KONDRU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-8490
Mailing address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-8490

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008-00121
NC
208M00000X
Hospitalist Physician
Primary
2008-00121
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0066524
NJ
05
0066524
SC
05
5908824
NC
Enumeration date
11/20/2006
Last updated
11/11/2020
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