Provider Demographics
NPI:1902975212
Name:KUNDA, PRABHA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHA
Middle Name:A
Last Name:KUNDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 SAIL POINTE LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3195
Mailing Address - Country:US
Mailing Address - Phone:423-842-3674
Mailing Address - Fax:423-842-4607
Practice Address - Street 1:6402 SAIL POINTE LN
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3195
Practice Address - Country:US
Practice Address - Phone:423-842-3674
Practice Address - Fax:423-842-4607
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA99282Medicare UPIN