Provider Demographics
NPI:1730632894
Name:THANDRA, ABHISHEK (MBBS)
Entity type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:
Last Name:THANDRA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 JODECO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:402-717-0800
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:CU DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2128
Practice Address - Country:US
Practice Address - Phone:402-717-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP7707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine